Provider Demographics
NPI:1407865124
Name:VANDORN, BUCK DUANE (O D)
Entity Type:Individual
Prefix:DR
First Name:BUCK
Middle Name:DUANE
Last Name:VANDORN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5402
Mailing Address - Country:US
Mailing Address - Phone:956-687-2875
Mailing Address - Fax:956-687-3128
Practice Address - Street 1:1804 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5402
Practice Address - Country:US
Practice Address - Phone:956-972-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB122590OtherMEDICARE