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Individual

DR. GLEN C VANDENBERGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
416 VALLEY VIEW DR # 100, SCOTTSBLUFF, NE 69361-1486
(308) 635-1633
(308) 635-2880
Mailing address
416 VALLEY VIEW DR # 100, SCOTTSBLUFF, NE 69361-1486
(308) 635-1633
(308) 635-2880

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
797
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1710903984
GROUP NPI
NE
01
1982600441
DR. VANDENBERGE NPI
Enumeration date
06/21/2005
Last updated
08/19/2008
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