Provider Demographics
NPI:1841662509
Name:DAVID M. VANDER VELDT O.D. INC.
Entity type:Organization
Organization Name:DAVID M. VANDER VELDT O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER VELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-561-6595
Mailing Address - Street 1:12041 LA PALMERA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-2007
Mailing Address - Country:US
Mailing Address - Phone:702-561-6595
Mailing Address - Fax:
Practice Address - Street 1:12041 LA PALMERA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-2007
Practice Address - Country:US
Practice Address - Phone:702-561-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty