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General NPI Number Information
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NPI Number | 1164819579
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Entity Type | Individual
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Provider Name | AUSTIN ANDERSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 11121 W 95TH ST PROFESSIONAL EYECARE
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City | OVERLAND PARK
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State | KS
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Zip | 66214-1824
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Country | US
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Telephone | 913-492-7728
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Fax | 913-492-5217
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Provider Business Mailing Address
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Address Line | 16325 S ALLMAN RD
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City | OLATHE
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State | KS
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Zip | 66062-9067
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Country | US
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Telephone | 402-540-0017
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 04-39234
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License Number State | KS
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