Provider Demographics
NPI:1780663195
Name:VANDERMEER, DIRK (OD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:
Last Name:VANDERMEER
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 1:72 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1360
Mailing Address - Country:US
Mailing Address - Phone:814-226-9505
Mailing Address - Fax:814-226-5169
Practice Address - Street 1:72 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1360
Practice Address - Country:US
Practice Address - Phone:814-226-9505
Practice Address - Fax:814-226-5169
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVA482591Medicare ID - Type Unspecified
PAT30664Medicare UPIN