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Contact Information

ANTHONY J VANDE WYDEVEN, OD
10522 VENICE BLVD
CULVER CITY, CA90232-3308
 Phone: 310-838-0521
 Fax: 310-839-6201
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Corneal and Contact Management

152WC0802X 41 Optometry
 

Occupational Vision

152WX0102X 41 Optometry
 

Pediatrics

152WP0200X 41 Optometry
 

Sports Vision

152WS0006X 41 Optometry
Indicates primary specialty

NPI Profile & details for ANTHONY J VANDE WYDEVEN · (Male)

NPI Number 1861413304
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 07/21/2006
Last updated 10/15/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 8132T
  • CA Medicaid SD0081320
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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