Individual
DR. BRIAN E VANDUSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3559 W RAMSEY ST, STE D-6, BANNING, CA 92220
(951) 849-2020
(951) 849-4869
Mailing address
34590 COUNTY LINE RD, STE 1, YUCAIPA, CA 92399-5303
(909) 795-2416
(909) 795-0477
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
007596T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0075960
—
CA
05
—
SD0075961
—
CA
Enumeration date
10/26/2007
Last updated
05/15/2018
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