Provider Demographics
NPI:1700920915
Name:DONALD J. VANDERFELTZ
Entity Type:Organization
Organization Name:DONALD J. VANDERFELTZ
Other - Org Name:VISION HEALTH EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANDERFELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-796-2222
Mailing Address - Street 1:202 E NORTH ST
Mailing Address - Street 2:P O BOX 246
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-1583
Mailing Address - Country:US
Mailing Address - Phone:573-796-2222
Mailing Address - Fax:573-796-4184
Practice Address - Street 1:202 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-1583
Practice Address - Country:US
Practice Address - Phone:573-796-2222
Practice Address - Fax:573-796-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504809906Medicaid
MO001013101Medicare PIN
MO0288460001Medicare NSC