Provider Demographics
NPI:1811347685
Name:VANDERLEI, CLARENCE JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:JOSEPH
Last Name:VANDERLEI
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 1:1529 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1127
Mailing Address - Country:US
Mailing Address - Phone:712-476-2692
Mailing Address - Fax:712-476-5225
Practice Address - Street 1:1529 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1127
Practice Address - Country:US
Practice Address - Phone:712-476-2692
Practice Address - Fax:712-476-5225
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD727152W00000X
IA094432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist