Provider Demographics
NPI:1396913026
Name:VAN OVER, MEGAN MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MARIE
Last Name:VAN OVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:MAASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:916 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2514
Mailing Address - Country:US
Mailing Address - Phone:480-963-7172
Mailing Address - Fax:480-782-1689
Practice Address - Street 1:916 W CHANDLER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2514
Practice Address - Country:US
Practice Address - Phone:480-963-7172
Practice Address - Fax:480-782-1689
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist