Provider Demographics
NPI:1811964794
Name:VANDER GRIEND, HARLAN JAY (OD)
Entity type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:JAY
Last Name:VANDER GRIEND
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 1:928 3RD AVENUE
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-0100
Mailing Address - Country:US
Mailing Address - Phone:712-324-2552
Mailing Address - Fax:712-324-2553
Practice Address - Street 1:928 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-0100
Practice Address - Country:US
Practice Address - Phone:712-324-2552
Practice Address - Fax:712-324-2553
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11753OtherWELLMARK INDV PAULLINA
IA33330OtherWELLMARK GROUP SHELDON
IAI7585OtherMEDICARE GROUP PAULLINA
IACS7580OtherRR MEDICARE GROUP SHELDON
IA0280586Medicaid
IA16177OtherMEDICARE INDV SHELDON
IA0280578OtherMEDICAID GROUP PAULLINA
IA0280586OtherMEDICAID GROUP SHELDON
IA11753OtherMEDICARE INDV PAULLINA
IA2161778OtherMEDICAID INDV PAULLINA
IAI7584OtherMEDICARE GROUP SHELDON
IA33340OtherWELLMARK GROUP PAULLINA
IACE1831OtherRR MEDICARE GROUP PAULLIN
IA2161778OtherMEDICAID INDV PAULLINA
IA0280586OtherMEDICAID GROUP SHELDON
IA33340OtherWELLMARK GROUP PAULLINA
IA0245980001Medicare NSC