1790855831 NPI number — ANDERSON EYE ASSOCIATES, LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790855831 NPI number — ANDERSON EYE ASSOCIATES, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON EYE ASSOCIATES, LTD
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:
Provider Other Organization Name Type Code:
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:
1790855831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
713 W OREGON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-4047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-623-8213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 CLARENDON AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAVOY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-355-7947
Provider Business Practice Location Address Fax Number:
217-355-8047
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
BETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-623-8213

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  042618867 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com