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General NPI Number Information
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NPI Number | 1821475427
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Entity Type | Individual
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Provider Name | WILLIAM D VANDECAR IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2015
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 9 MONROE PARKWAY SUITE 160
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City | LAKE OSWERGO
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State | OR
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Zip | 97035
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Country | US
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Telephone | 503-636-2551
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Fax | 503-636-3055
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Provider Business Mailing Address
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Address Line | PO BOX 22009
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City | PORTLAND
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State | OR
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Zip | 97269
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Country | US
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Telephone | 503-558-7372
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Fax | 503-344-5140
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD61417092
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 8219851
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD228671
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License Number State | OR
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