Provider Demographics
NPI:1699914135
Name:MARK S. VOGEL
Entity type:Organization
Organization Name:MARK S. VOGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-654-2020
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-654-2020
Mailing Address - Fax:631-654-0606
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:SUITE 4C
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-654-2020
Practice Address - Fax:631-654-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003491-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty