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NPI Code Detail

MEDICARE: DONALD J. VANDERFELTZ

MEDICARE: DONALD J. VANDERFELTZ
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
1152W00000XOptometristT02337MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700920915
Entity Type Code : Organization
Provider Name (Legal Business Name) : DONALD J. VANDERFELTZ
Provider Business Mailing Address
First Line : 202 E NORTH ST
Second Line : P O BOX 246
City : CALIFORNIA
State : MO
Zip : 65018-1583
Country : US
Telephone Number : 573-796-2222
Fax Number : 573-796-4184
Provider Business Practice Location Address
First Line : 202 E NORTH ST
Second Line :
City : CALIFORNIA
State : MO
Zip : 65018-1583
Country : US
Telephone Number : 573-796-2222
Fax Number : 573-796-4184
Authorized Official
Title or Position : OWNER
Name : DONALD J VANDERFELTZ
Credential : O.D.
Telephone Number : 573-796-2222
Provider Enumeration Date : 02/19/2007
Last Update Date : 12/22/2009

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Directions to “DONALD J. VANDERFELTZ ” Practice Location

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