Healthcare Provider Details

I. General information

NPI: 1669380341
Provider Name (Legal Business Name): ROBERT CHARLES ANDERSON LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 US HIGHWAY 80 W UNIT A
POOLER GA
31322-2504
US

IV. Provider business mailing address

104 US HIGHWAY 80 W UNIT A
POOLER GA
31322-2504
US

V. Phone/Fax

Practice location:
  • Phone: 912-330-1200
  • Fax:
Mailing address:
  • Phone: 912-330-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO001726
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: