Provider Demographics
NPI:1265201925
Name:VANG, DER (OD)
Entity type:Individual
Prefix:
First Name:DER
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26031 N 53RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-6349
Mailing Address - Country:US
Mailing Address - Phone:559-387-9155
Mailing Address - Fax:
Practice Address - Street 1:15003 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3244
Practice Address - Country:US
Practice Address - Phone:623-931-2943
Practice Address - Fax:623-583-2253
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty