Charles R Vandervort, OD in Green River, WY - Medicare Optometrist Provider

Charles R Vandervort, OD is a medicare enrolled "Optometrist" provider in Green River, Wyoming. His current practice location is 665 Uinta Dr, Green River, Wyoming. You can reach out to his office (for appointments etc.) via phone at (307) 875-4538.

Charles R Vandervort is licensed to practice in Wyoming (license number 101T) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1629047758.

Contact Information

	Charles R Vandervort, OD
	665 Uinta Dr, Green River, WY 82935-5031
	(307) 875-4538
	(307) 875-8997

Healthcare Provider's Profile

Full Name	Charles R Vandervort
Gender	Male
Speciality	Optometrist
Location	665 Uinta Dr, Green River, Wyoming
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1629047758
Provider Enumeration Date: 03/14/2006
Last Update Date: 09/17/2012

Medicare PECOS Information:

PECOS PAC ID: 2466400551
Enrollment ID: I20050105000612

Medical Identifiers

Medical identifiers for Charles R Vandervort such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1629047758	NPI	-	NPPES
114697100	Medicaid	WY
001798001	Other	WY	BLUE CROSS BLUE SHIELD
410040553	Other	WY	RAILROAD MEDICARE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
152W00000X	Optometrist	101T (Wyoming)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Charles R Vandervort is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Charles R Vandervort, OD 665 Uinta Dr, Green River, WY 82935-5031 Ph: (307) 875-4538	Charles R Vandervort, OD 665 Uinta Dr, Green River, WY 82935-5031 Ph: (307) 875-4538

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Optometrist in Green River, WY

Dr. Jeffrey A Wilson, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 170 Commerce Dr Ste C, Green River, WY 82935 Phone: 307-875-3399 Fax: 307-875-3778
Dr. Amasa L Mecham, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 170 Commerce Dr Ste C, Green River, WY 82935 Phone: 307-875-3399
Eye Care Specialists Of Green River Optometrist Medicare: Not Enrolled in Medicare Practice Location: 665 Uinta Dr, Green River, WY 82935 Phone: 307-875-4538 Fax: 307-875-8997
Desert View Eye Care, Lc Optometrist Medicare: Medicare Enrolled Practice Location: 170 Commerce Dr Ste C, Green River, WY 82935 Phone: 307-875-3399 Fax: 307-875-3778

Charles R Vandervort, OD - Medicare Optometrist in Green River, WY