Individual
CHARLES TUCKER VANDYCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
9239 W CENTER RD, SUITE 103, OMAHA, NE 68124-1900
(402) 898-3232
(402) 898-3234
Mailing address
9239 W CENTER RD, SUITE 103, OMAHA, NE 68124-1900
(402) 898-3232
(402) 898-3234
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0601800375
VA
152W00000X
Optometrist
1388
LA
152W00000X
Optometrist
5514T2426
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06421052
—
CO
05
—
1476471
—
LA
05
—
710115320
—
KY
05
—
9237330
—
VA
Enumeration date
05/16/2006
Last updated
03/23/2011
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