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General NPI Number Information
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NPI Number | 1407816622
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Entity Type | Individual
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Provider Name | MICHAEL RICHARD VANDEVEER O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 5500 ARMSTRONG RD EYE CLINIC (123)
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City | BATTLE CREEK
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State | MI
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Zip | 49037-7314
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Country | US
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Telephone | 269-966-5600
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Fax | 269-223-5243
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Provider Business Mailing Address
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Address Line | 5500 ARMSTRONG RD EYE CLINIC (123)
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City | BATTLE CREEK
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State | MI
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Zip | 49037-7314
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Country | US
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Telephone | 269-966-5600
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Fax | 269-223-5243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901003214
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License Number State | MI
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