Healthcare Provider Details

I. General information

NPI: 1528628062
Provider Name (Legal Business Name): SHELBY K ANDERSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 S MINNESOTA AVE
SIOUX FALLS SD
57105-1743
US

IV. Provider business mailing address

1621 S MINNESOTA AVE
SIOUX FALLS SD
57105-1743
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-9200
  • Fax: 605-328-9201
Mailing address:
  • Phone: 605-328-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number761
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3624
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: