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General NPI Number Information
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NPI Number | 1437338407
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Entity Type | Individual
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Provider Name | BRIAN E VANDUSEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 3559 W RAMSEY ST STE D-6
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City | BANNING
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State | CA
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Zip | 92220
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Country | US
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Telephone | 951-849-2020
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Fax | 951-849-4869
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Provider Business Mailing Address
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Address Line | 34590 COUNTY LINE RD STE 1
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City | YUCAIPA
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State | CA
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Zip | 92399-5303
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Country | US
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Telephone | 909-795-2416
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Fax | 909-795-0477
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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 | 007596T
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License Number State | CA
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