Provider Demographics
NPI:1790988558
Name:BRIAN J VANDERPLOEG, OD, PLLC
Entity Type:Organization
Organization Name:BRIAN J VANDERPLOEG, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPLOEG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-968-6860
Mailing Address - Street 1:4801 OUTER LOOP
Mailing Address - Street 2:D-648
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3201
Mailing Address - Country:US
Mailing Address - Phone:502-968-6860
Mailing Address - Fax:502-969-5293
Practice Address - Street 1:4801 OUTER LOOP
Practice Address - Street 2:D-648
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3201
Practice Address - Country:US
Practice Address - Phone:502-968-6860
Practice Address - Fax:502-969-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1672DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty