Provider Demographics
NPI:1295833606
Name:VANDER MEER, ROBERT C (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:VANDER MEER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:248 MILLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4125
Practice Address - Country:US
Practice Address - Phone:505-426-8866
Practice Address - Fax:505-426-8601
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP7008Medicaid
NMP00343299OtherRRB MEDICARE RAILROAD
NMNM00PA48OtherBC BS OF NM
NMP7008Medicaid
NMT40692Medicare UPIN