Provider Demographics
NPI:1699966762
Name:LILIEN VOGL OD PC
Entity type:Organization
Organization Name:LILIEN VOGL OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIEN
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:VOGL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-877-3007
Mailing Address - Street 1:10750 W. MC DOWELL RD.
Mailing Address - Street 2:BLDG A #100
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5651
Mailing Address - Country:US
Mailing Address - Phone:623-877-3007
Mailing Address - Fax:623-877-4488
Practice Address - Street 1:10750 W. MC DOWELL RD.
Practice Address - Street 2:BLDG A #100
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5651
Practice Address - Country:US
Practice Address - Phone:623-877-3007
Practice Address - Fax:623-877-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0989261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z71841Medicare PIN
T82532Medicare UPIN
4660750001Medicare NSC
Z71840Medicare PIN