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Individual

DR. KEVIN BENJAMIN VANDENBOSCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1116 W GANSON ST, JACKSON, MI 49202-4240
(877) 852-8463
(517) 782-5166
Mailing address
4615 BREMER ST SW, GRANDVILLE, MI 49418-2239
(616) 240-5632

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004710
MI

Other

Enumeration date
06/14/2012
Last updated
06/14/2012
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