Provider Demographics
NPI:1952598500
Name:R VANDERHOOF INC.
Entity Type:Organization
Organization Name:R VANDERHOOF INC.
Other - Org Name:R VANDERHOOF INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VANDERHOOF
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:413-786-0719
Mailing Address - Street 1:338 WALNUT STREET EXT
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1524
Mailing Address - Country:US
Mailing Address - Phone:413-786-0719
Mailing Address - Fax:413-789-4717
Practice Address - Street 1:338 WALNUT STREET EXT
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1524
Practice Address - Country:US
Practice Address - Phone:413-786-0719
Practice Address - Fax:413-789-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5216332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0424310002Medicare NSC