Provider Demographics
NPI:1851496962
Name:VERMEER, DOUGLAS J (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:VERMEER
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 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1651
Mailing Address - Country:US
Mailing Address - Phone:507-825-5401
Mailing Address - Fax:507-825-5263
Practice Address - Street 1:105 MAIN ST W
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1651
Practice Address - Country:US
Practice Address - Phone:507-825-5401
Practice Address - Fax:507-825-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN789523200Medicaid
MN419000712Medicare ID - Type Unspecified
MN789523200Medicaid
MNT92809Medicare UPIN