1437287554 NPI number — JEFFREY L. ANDERSON O.D.

Table of content: JOANNA LYNN MARTIN CRNA (NPI 1114240611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437287554 NPI number — JEFFREY L. ANDERSON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY L. ANDERSON O.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY EYE CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437287554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 2ND AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55912-3165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-437-3227
Provider Business Mailing Address Fax Number:
507-437-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 2ND AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55912-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-437-3227
Provider Business Practice Location Address Fax Number:
507-437-8070
Provider Enumeration Date:
03/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
LEON
Authorized Official Title or Position:
OWNER OPTOMETRIST
Authorized Official Telephone Number:
507-437-3227

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2665 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)