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General NPI Number Information
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NPI Number | 1962735282
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Entity Type | Organization
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Legal Business Name | VAN OPTICAL, P.C.
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 7000 E MICHIGAN AVE
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City | SALINE
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State | MI
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Zip | 48176-9514
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Country | US
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Telephone | 734-944-3782
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Fax | 734-944-3793
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Provider Business Mailing Address
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Address Line | 8850 SALINE MILAN RD
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City | SALINE
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State | MI
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Zip | 48176-8826
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Country | US
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Telephone | 734-944-4404
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Fax | 734-944-3937
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Authorized Official
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Title or Position | PRESIDENT OPTOMETRIST
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Name | DR. DAVID GORDON VANOTTEREN
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Credential | O.D., M.S.
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Telephone | 734-944-4404
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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 | 4901003594
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License Number State | MI
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