Individual
JOHN LOGAN VANKESTEREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
400 EUBANK BLVD NE, SUITE A, ALBUQUERQUE, NM 87123-2758
(505) 293-0417
(505) 293-4761
Mailing address
3707 CAMINO DON DIEGO NE, ALBUQUERQUE, NM 87111-3905
(505) 275-1537
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2306
CO
152W00000X
Optometrist
Primary
552
NM
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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