Dustin Vermeulen OD & Associates PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1303 Issued in AZ

Legal business name

DUSTIN VERMEULEN OD & ASSOCIATES PLLC

Practice address

4824 E Baseline Rd
Ste 140
Mesa, AZ 85206-4676

Phone

(480) 969-4040

Fax

(480) 830-1402

NPI assigned

Jan 31, 2011

Last updated

Jan 31, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robin Nice

Title

Billing Manager

Phone

(480) 969-4040

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1881990463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 E BASELINE RD",
            "address_2": "STE 140",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064676",
            "telephone_number": "480-969-4040",
            "fax_number": "480-830-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 E BASELINE RD",
            "address_2": "STE 140",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064676",
            "telephone_number": "480-969-4040",
            "fax_number": "480-830-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUSTIN VERMEULEN OD & ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-31",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "NICE",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "480-969-4040"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; 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.