Individual
DR. ELLEN BLAIR VANDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
10701 EAST BLVD, CLEVELAND, OH 44106-1702
(216) 791-3800
Mailing address
PO BOX 304, LOWELL, OH 45744-0304
(740) 516-4216
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005363
MI
Other
Enumeration date
06/01/2018
Last updated
08/20/2019
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