Healthcare Provider Details

I. General information

NPI: 1639340979
Provider Name (Legal Business Name): VAN G. DELLINGER, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W CHURCH ST
CHERRYVILLE NC
28021-2805
US

IV. Provider business mailing address

PO BOX 160
CHERRYVILLE NC
28021-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-2020
  • Fax: 704-435-5267
Mailing address:
  • Phone: 704-435-2020
  • Fax: 704-435-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1182
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1182
License Number StateNC

VIII. Authorized Official

Name: DR. VAN G DELLINGER
Title or Position: OPTOMETRIST
Credential: OD
Phone: 704-435-2020