Basic Information
| Provider Information | |||||||||
| NPI: | 1336159755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOGEL | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LIVIERATOS | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O. D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10921 WILSHIRE BLVD | ||||||||
| Address2: | STE 900 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900244003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104538911 | ||||||||
| FaxNumber: | 3104532519 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 N ROXBURY DR FL 3 | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902104238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104538911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | (OPT) 12453 | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | (OPT) 12453 | 01 | CA | STATE LICENSE | OTHER | W14005 | 01 | CA | ASSIL EYE INSTITUTE GROUP MEDICARE | OTHER | ML1278666 | 01 | CA | DEA | OTHER |