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General NPI Number Information
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NPI Number | 1124968466
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Entity Type | Organization
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Legal Business Name | DAVID ANDERSON OD LLC
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 3640 CORPORATE TRAIL DR
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City | EARTH CITY
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State | MO
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Zip | 63045-1122
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Country | US
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Telephone | 314-388-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 MANCHESTER AVE APT 305
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2166
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ANDERSON
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Credential | OD
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Telephone | 573-230-3652
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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 |
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License Number State |
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