Provider Demographics
NPI:1245221423
Name:VANDEMARK, JOHN ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:VANDEMARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:ERIC
Other - Last Name:VANDEMARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1318 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3703
Mailing Address - Country:US
Mailing Address - Phone:419-452-4378
Mailing Address - Fax:419-425-4377
Practice Address - Street 1:1318 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3703
Practice Address - Country:US
Practice Address - Phone:419-452-4378
Practice Address - Fax:419-425-4377
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2925 T688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1104098920OtherBUSINESS NPI
OH1245221423Medicare UPIN
OH1104098920OtherBUSINESS NPI
OH1308880001Medicare NSC