Provider Demographics
NPI:1912867243
Name:VANVLECK, DAVID (LDO)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VANVLECK
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 COMMERCE DR NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4583
Mailing Address - Country:US
Mailing Address - Phone:800-922-5525
Mailing Address - Fax:
Practice Address - Street 1:411 COMMERCE DR NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4583
Practice Address - Country:US
Practice Address - Phone:800-922-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002514156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician