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General NPI Number Information
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NPI Number | 1023798790
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Entity Type | Individual
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Provider Name | DAVID ANDERSON OD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 3533 DUNN RD
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City | FLORISSANT
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State | MO
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Zip | 63033-6783
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Country | US
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Telephone | 314-838-2100
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Fax | 314-838-0607
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Provider Business Mailing Address
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Address Line | 15933 CLAYTON RD STE 210
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City | BALLWIN
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State | MO
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Zip | 63011-2172
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC6304
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2024016097
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License Number State | MO
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