Charles R. Vandervort, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

101T Issued in WY

Practice address

665 Uinta Dr
Green River, WY 82935-5031

Phone

(307) 875-4538

Fax

(307) 875-8997

NPI assigned

Mar 14, 2006

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arnold Family Chiropractic PC

  • Clinic/Center
  • Green River, WY
  • NPI 1619476454
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1629047758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 UINTA DR",
            "city": "GREEN RIVER",
            "state": "WY",
            "postal_code": "829355031",
            "telephone_number": "307-875-4538",
            "fax_number": "307-875-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 UINTA DR",
            "city": "GREEN RIVER",
            "state": "WY",
            "postal_code": "829355031",
            "telephone_number": "307-875-4538",
            "fax_number": "307-875-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERVORT",
        "first_name": "CHARLES",
        "middle_name": "R.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WY",
            "license": "101T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114697100",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001798001",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410040553",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Renee Thompson, APRN
• Malinda Ranee Tollefson, MSW, LCSW
• Tiffanie S Toone, PHARMD
• Mara Trumble
• Tara Vanderpool
• Christa J Vandervort, SP
• Svetlana Wells, PHARM.D
• Elena Wendel, RDN
• Donald C. West, D.D.S.
• Aja Witt

• Optometrist in Green River, WY
• Providers in Green River, WY by specialty
• Optometrist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.