MEDICARE: DR. DAVID M ANDERSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5457	OH

General Provider Information

NPI Number	:	1497759344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M ANDERSON O.D.

Provider Business Mailing Address
First Line	:	340 ALEXANDERSVILLE RD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-2554
Country	:	US
Telephone Number	:	937-866-3471
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 ALEXANDERSVILLE RD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-2554
Country	:	US
Telephone Number	:	937-866-3471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/03/2013

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