Individual
STEPHEN J VANDYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1611 ANNE ST NW, BEMIDJI, MN 56601-5114
(218) 333-2020
(218) 333-2019
Mailing address
1611 ANNE ST NW, BEMIDJI, MN 56601-5114
(218) 333-2020
(218) 333-2019
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1839
MN
152WC0802X
Corneal and Contact Management Optometrist
1839
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016323600
—
MN
01
—
10723
ND BCBS
—
01
—
2219746
MEDICA
—
01
—
49B66VA
MN BCBS
—
01
—
912049
PREFERREDONE
—
01
—
934731
AMERICAS PPO
—
01
—
HP17316
HEALTHPARTNERS
—
Enumeration date
08/24/2006
Last updated
12/16/2011
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