Healthcare Provider Details

I. General information

NPI: 1801064837
Provider Name (Legal Business Name): ANDERSON EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CAMPAU AVE NW RIVERFRONT PLAZA BLDG-SUITE #10
GRAND RAPIDS MI
49503-2642
US

IV. Provider business mailing address

55 CAMPAU AVE NW RIVERFRONT PLAZA BLDG-SUITE #10
GRAND RAPIDS MI
49503-2642
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7380
  • Fax: 616-459-5752
Mailing address:
  • Phone: 616-459-7380
  • Fax: 616-459-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GARY A ANDERSON
Title or Position: OWNER
Credential: O.D.
Phone: 616-459-7380