Individual
DAVID G VANDERLOOP II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1901 CROOKS AVE STE C, KAUKAUNA, WI 54130-3200
(920) 372-2555
(920) 949-4025
Mailing address
823 GRIGNON ST, KAUKAUNA, WI 54130-1643
(920) 205-5810
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2991
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38624300
—
WI
Enumeration date
05/19/2006
Last updated
12/26/2018
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