Individual
DR. HENRICUS VANVEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1001 N GRAND AVE, TAHLEQUAH, OK 74464-7017
(918) 458-2109
(918) 458-2310
Mailing address
1001 N GRAND AVE, TAHLEQUAH, OK 74464-7017
(918) 456-5511
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
968
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100763580B
—
OK
05
—
314003609
—
MO
05
—
3186690001
—
KS
01
—
410031824
RAILROAD MEDICARE-COMMERCIAL NUMBER
—
01
—
512908450
DMERC-TAX EXEMPT NUMBER
—
Enumeration date
07/17/2006
Last updated
08/04/2008
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