Glen C Vandenberge, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

797 Issued in NE

Practice address

416 Valley View Dr # 100
Scottsbluff, NE 69361-1486

Phone

(308) 635-1633

Fax

(308) 635-2880

NPI assigned

Jun 21, 2005

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1982600441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 VALLEY VIEW DR # 100",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693611486",
            "telephone_number": "308-635-1633",
            "fax_number": "308-635-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 VALLEY VIEW DR # 100",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693611486",
            "telephone_number": "308-635-1633",
            "fax_number": "308-635-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBERGE",
        "first_name": "GLEN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. VANDENBERGE NPI",
            "identifier": "1982600441",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1710903984",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriela Valverde, RN IBCLC
• Kayla Richelle Lee Van Hoosear
• William Scott Van Noy, D.D.S.
• Lisa K Van Winkle, PLADC
• Ross Martin Vanamburg, OTR/L
• Natalie Marie Vasquez
• Bertana Marie Venturino
• Erika Y Venzor
• Danielle Villagrana
• Alicia Villanueva

• Optometrist in Scottsbluff, NE
• Providers in Scottsbluff, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.