Brian E Vandusen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

007596T Issued in CA

Practice address

3559 W Ramsey St
Ste D-6
Banning, CA 92220

Phone

(951) 849-2020

Fax

(951) 849-4869

NPI assigned

Oct 26, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1437338407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34590 COUNTY LINE RD",
            "address_2": "STE 1",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995303",
            "telephone_number": "909-795-2416",
            "fax_number": "909-795-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3559 W RAMSEY ST",
            "address_2": "STE D-6",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "92220",
            "telephone_number": "951-849-2020",
            "fax_number": "951-849-4869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDUSEN",
        "first_name": "BRIAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-26",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "007596T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0075960",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0075961",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Georgina Valentine
• Alan A Valenzuela, PA-C
• Adan Vasquez
• Sandra Velazquez Perkins, PA-C
• Ana Bertha Veliz
• Roberta A Verdugo, LCSW
• Verio Healthcare, Inc

• Optometrist in Banning, CA
• Providers in Banning, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.