1184821472 NPI number — DR. ERIN C. VOGT STROMBERG O.D.

Table of content: DR. ERIN C. VOGT STROMBERG O.D. (NPI 1184821472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184821472 NPI number — DR. ERIN C. VOGT STROMBERG O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOGT STROMBERG
Provider First Name:
ERIN
Provider Middle Name:
C.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOGT
Provider Other First Name:
ERIN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184821472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 LASKIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23451-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-428-1675
Provider Business Mailing Address Fax Number:
757-491-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 LASKIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23451-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-428-1675
Provider Business Practice Location Address Fax Number:
757-491-3150
Provider Enumeration Date:
06/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618001651 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)