Healthcare Provider Details

I. General information

NPI: 1093569840
Provider Name (Legal Business Name): RICHARD L. ANDERSON, O.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S A ST
OXNARD CA
93030-5804
US

IV. Provider business mailing address

363 S A ST
OXNARD CA
93030-5804
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-6619
  • Fax: 805-487-5359
Mailing address:
  • Phone: 805-483-6619
  • Fax: 805-487-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD L ANDERSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 805-483-6619