Healthcare Provider Details

I. General information

NPI: 1609833227
Provider Name (Legal Business Name): EDWIN GWIN ANDERSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E LOCUST ST
DRESDEN TN
38225-1440
US

IV. Provider business mailing address

PO BOX 31
DRESDEN TN
38225-0031
US

V. Phone/Fax

Practice location:
  • Phone: 731-364-2150
  • Fax: 731-364-5157
Mailing address:
  • Phone: 731-364-2150
  • Fax: 731-364-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: