Provider Demographics
NPI:1275889446
Name:VANDERHOOF, KATE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-4406
Mailing Address - Country:US
Mailing Address - Phone:586-337-4708
Mailing Address - Fax:586-296-7256
Practice Address - Street 1:33080 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2038
Practice Address - Country:US
Practice Address - Phone:586-296-7250
Practice Address - Fax:586-296-7256
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004730OtherSTATE OF MICHGIAN
MIP41880009Medicare PIN
MIP41870009Medicare PIN