Individual
JILL MOGIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2821 N BALLAS RD STE C11, SAINT LOUIS, MO 63131-2313
(833) 376-6445
(314) 312-6984
Mailing address
PO BOX 11805, CLAYTON, MO 63105-0605
(888) 376-6445
(314) 312-6984
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046007879
IL
152W00000X
Optometrist
TO2571
MO
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
T02571
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009359551
AETNA
—
01
—
1285953844
PROVIDER NPI NUMBER
—
01
—
991722003
MEDICARE PART B
MO
Enumeration date
05/21/2010
Last updated
07/01/2021
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