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General NPI Number Information
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NPI Number | 1144358599
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Entity Type | Organization
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Legal Business Name | JOHN E. ANDERSON O.D.,LTD
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 512 W BURLINGTON AVE SUITE 106
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City | LA GRANGE
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State | IL
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Zip | 60525-2221
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Country | US
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Telephone | 708-354-7001
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Fax | 708-354-0716
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Provider Business Mailing Address
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Address Line | 512 W BURLINGTON AVE SUITE 106
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City | LA GRANGE
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State | IL
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Zip | 60525-2221
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Country | US
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Telephone | 708-354-7001
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Fax | 708-354-0716
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN ERIC ANDERSON
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Credential | O.D.
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Telephone | 708-354-7001
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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 | 046007314
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License Number State | IL
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