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General NPI Number Information
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NPI Number | 1376606681
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Entity Type | Organization
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Legal Business Name | BLUFFS VISION CARE
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1441 10TH ST
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City | GERING
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State | NE
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Zip | 69341-2816
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Country | US
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Telephone | 308-633-2020
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Fax | 308-633-7623
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Provider Business Mailing Address
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Address Line | 416 VALLEY VIEW DR # 100
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-1486
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Country | US
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Telephone | 308-635-1633
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Fax | 308-635-2880
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. GLEN C VANDENBERGE
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Credential | OD
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Telephone | 308-635-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 797
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1223
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License Number State | NE
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