Provider Demographics
NPI:1790770816
Name:VANDERHOOF, ARLIE (OD)
Entity Type:Individual
Prefix:
First Name:ARLIE
Middle Name:
Last Name:VANDERHOOF
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 26010
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-6010
Mailing Address - Country:US
Mailing Address - Phone:586-296-7250
Mailing Address - Fax:586-296-0276
Practice Address - Street 1:33080 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2038
Practice Address - Country:US
Practice Address - Phone:586-296-7250
Practice Address - Fax:586-296-0276
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5189604Medicaid
MI5189613Medicaid
MIP00406929Medicare PIN
T33209Medicare UPIN
MIP41870003Medicare ID - Type Unspecified
MI5189604Medicaid