Provider Demographics
NPI:1669647228
Name:VINCENT VAN HOUTEN, O.D., PC
Entity type:Organization
Organization Name:VINCENT VAN HOUTEN, O.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:VAN HOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-469-5556
Mailing Address - Street 1:325 5TH ST
Mailing Address - Street 2:LOCATED IN THE OPTICAL SHOPPE
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9658
Mailing Address - Country:US
Mailing Address - Phone:541-469-5556
Mailing Address - Fax:541-469-2875
Practice Address - Street 1:325 5TH ST
Practice Address - Street 2:LOCATED IN THE OPTICAL SHOPPE
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9658
Practice Address - Country:US
Practice Address - Phone:541-469-5556
Practice Address - Fax:541-469-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2990T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty