Individual
DR. RUSSELL VANGELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
908 JEFFERSON ST, SEATTLE, WA 98104-2433
(206) 744-4142
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD00049129
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232087
L&I
WA
05
—
1730180985
—
WA
Enumeration date
08/09/2005
Last updated
01/02/2013
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