Provider Demographics
NPI:1023128691
Name:VANDE GARDE, TRENT L (MD)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:L
Last Name:VANDE GARDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW CORPORATE VIEW
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615
Mailing Address - Country:US
Mailing Address - Phone:785-235-3322
Mailing Address - Fax:785-235-1217
Practice Address - Street 1:619 SW CORPORATE VIEW
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615
Practice Address - Country:US
Practice Address - Phone:785-235-3322
Practice Address - Fax:785-235-1217
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28231207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS180042685OtherPALMETTO GBA
KS100421700AMedicaid
KS101177OtherBCBS OF KS
KSG97854Medicare UPIN
KS100421700AMedicaid