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General NPI Number Information
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NPI Number | 1881990463
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Entity Type | Organization
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Legal Business Name | DUSTIN VERMEULEN OD & ASSOCIATES PLLC
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 4824 E BASELINE RD STE 140
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City | MESA
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State | AZ
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Zip | 85206-4676
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Country | US
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Telephone | 480-969-4040
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Fax | 480-830-1402
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Provider Business Mailing Address
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Address Line | 4824 E BASELINE RD STE 140
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City | MESA
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State | AZ
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Zip | 85206-4676
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Country | US
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Telephone | 480-969-4040
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Fax | 480-830-1402
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ROBIN NICE
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Credential |
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Telephone | 480-969-4040
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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 | 1303
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License Number State | AZ
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