Healthcare Provider Details

I. General information

NPI: 1821160102
Provider Name (Legal Business Name): RICHARD B. ANDERSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E MEXICO AVE STE 102
DENVER CO
80210-3941
US

IV. Provider business mailing address

3900 E MEXICO AVE STE 102
DENVER CO
80210-3941
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-1001
  • Fax: 720-524-1121
Mailing address:
  • Phone: 720-524-1001
  • Fax: 720-524-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCO 1350
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPV.0000003
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: