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General NPI Number Information
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NPI Number | 1972667384
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Entity Type | Individual
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Provider Name | DUSTIN VERMEULEN OD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 4824 E BASELINE RD SUITE 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 | 480-830-9202
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Provider Business Mailing Address
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Address Line | 4824 E BASELINE RD SUITE 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 | 480-830-9202
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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 | 1303
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 948
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License Number State | NV
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