Provider Demographics
NPI:1467536821
Name:DELLINGER, VAN G (OD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:G
Last Name:DELLINGER
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-0160
Mailing Address - Country:US
Mailing Address - Phone:704-435-2020
Mailing Address - Fax:704-435-5267
Practice Address - Street 1:201 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-2805
Practice Address - Country:US
Practice Address - Phone:704-435-2020
Practice Address - Fax:704-435-5267
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909223Medicaid
NC09223OtherBCBS PROVIDER
NC246508Medicare PIN
NC7909223Medicaid