Healthcare Provider Details

I. General information

NPI: 1346422607
Provider Name (Legal Business Name): DR KEVIN ANDERSON & ASSOCIATES, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 BOARDWALK DR SUITE 100
FORT COLLINS CO
80525-5931
US

IV. Provider business mailing address

4103 BOARDWALK DR SUITE 100
FORT COLLINS CO
80525-5931
US

V. Phone/Fax

Practice location:
  • Phone: 970-223-0592
  • Fax: 970-377-1082
Mailing address:
  • Phone: 970-223-0592
  • Fax: 970-377-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 1342
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCO1342
License Number StateCO

VIII. Authorized Official

Name: MS. DEBI WELBORN
Title or Position: OFFICE MANAGER
Credential:
Phone: 970-223-0592