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NPI Code Detail

MEDICARE: COLE EDWARD VANDERFELTZ OD

MEDICARE: COLE EDWARD VANDERFELTZ OD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2152W00000XOptometrist2024018653MO

General Provider Information

NPI Number : 1740061621
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLE EDWARD VANDERFELTZ OD
Provider Business Mailing Address
First Line : 500 N KEENE ST STE 103
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-8104
Country : US
Telephone Number : 573-874-2030
Fax Number : 573-449-0253
Provider Business Practice Location Address
First Line : 202 E NORTH ST
Second Line :
City : CALIFORNIA
State : MO
Zip : 65018-1583
Country : US
Telephone Number : 573-874-2030
Fax Number : 573-449-0253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2023
Last Update Date : 05/29/2024

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Directions to “ COLE EDWARD VANDERFELTZ OD” Practice Location

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