Healthcare Provider Details

I. General information

NPI: 1124968466
Provider Name (Legal Business Name): DAVID ANDERSON OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CORPORATE TRAIL DR
EARTH CITY MO
63045-1122
US

IV. Provider business mailing address

4321 MANCHESTER AVE APT 305
SAINT LOUIS MO
63110-2166
US

V. Phone/Fax

Practice location:
  • Phone: 314-388-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID ANDERSON
Title or Position: OWNER
Credential: OD
Phone: 573-230-3652