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General NPI Number Information
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NPI Number | 1952598500
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Entity Type | Organization
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Legal Business Name | R VANDERHOOF INC.
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 338 WALNUT STREET EXT
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City | AGAWAM
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State | MA
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Zip | 01001-1524
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Country | US
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Telephone | 413-786-0719
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Fax | 413-789-4717
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Provider Business Mailing Address
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Address Line | 338 WALNUT STREET EXT
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City | AGAWAM
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State | MA
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Zip | 01001-1524
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Country | US
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Telephone | 413-786-0719
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Fax | 413-789-4717
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Authorized Official
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Title or Position | OWNER
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Name | MR. AARON MICHAEL VANDERHOOF
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Credential | RDO
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Telephone | 413-786-0719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5216
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License Number State | MA
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