Provider Demographics
NPI:1518177708
Name:VANVEEN, DEREK P (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:P
Last Name:VANVEEN
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 1:5823 CALHOUN MEMORIAL HWY STE 2A
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3874
Mailing Address - Country:US
Mailing Address - Phone:864-855-6571
Mailing Address - Fax:864-885-5230
Practice Address - Street 1:5823 CALHOUN MEMORIAL HWY STE 2A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3874
Practice Address - Country:US
Practice Address - Phone:864-855-6571
Practice Address - Fax:864-855-2303
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1808152W00000X
SC1180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist