Provider Demographics
NPI:1407816622
Name:VANDEVEER, MICHAEL RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:VANDEVEER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 ARMSTRONG RD
Mailing Address - Street 2:EYE CLINIC (123)
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7314
Mailing Address - Country:US
Mailing Address - Phone:269-966-5600
Mailing Address - Fax:269-223-5243
Practice Address - Street 1:5500 ARMSTRONG RD
Practice Address - Street 2:EYE CLINIC (123)
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-7314
Practice Address - Country:US
Practice Address - Phone:269-966-5600
Practice Address - Fax:269-223-5243
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040082Medicare PIN