Vande Wydeven, Anthony John
Vande Wydeven, Anthony John is an sole proprietor health care provider with primary practice located at 10522 Venice Blvd , Culver City CA 90232-3308. He recently has 5 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Pediatrics, Eye and Vision Services Providers / Sports Vision, Eye and Vision Services Providers / Occupational Vision. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Vande Wydeven, Anthony John can be contacted via phone (310) 838-0521.Contact Information
Primary practice address
10522 Venice Blvd
Culver City CA 90232-3308
Phone: (310) 838-0521
Fax: (310) 839-6201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 8132T | California |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 8132T | California |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | 8132T | California |
| Eye and Vision Services Providers / Sports Vision | 152WS0006X | 8132T | California |
| Eye and Vision Services Providers / Occupational Vision | 152WX0102X | 8132T | California |
Profile Details
| NPI number | 1861413304 |
|---|---|
| LBN Legal business name | Vande Wydeven, Anthony John |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 21st, 2006 |
| Last updated | Oct 15th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861413304 | NPPES |
| California | MEDICAID | SD0081320 |
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