MEDICARE: VAN G. DELLINGER, OD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	1182	NC
2	152W00000X	Optometrist	1182	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09223	OTHER	NC	BCBS PROVIDER

General Provider Information

NPI Number	:	1639340979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN G. DELLINGER, OD, PA

Provider Business Mailing Address
First Line	:	PO BOX 160
Second Line	:
City	:	CHERRYVILLE
State	:	NC
Zip	:	28021-0160
Country	:	US
Telephone Number	:	704-435-2020
Fax Number	:	704-435-5267

Provider Business Practice Location Address
First Line	:	201 W CHURCH ST
Second Line	:
City	:	CHERRYVILLE
State	:	NC
Zip	:	28021-2805
Country	:	US
Telephone Number	:	704-435-2020
Fax Number	:	704-435-5267

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. VAN G DELLINGER
Credential	:	OD
Telephone Number	:	704-435-2020

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	12/02/2009

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