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General NPI Number Information
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NPI Number | 1205991692
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Entity Type | Individual
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Provider Name | JEREMY R ANDERSON OD
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 120 12TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2528
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Country | US
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Telephone | 320-763-4321
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Fax | 320-763-6921
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Provider Business Mailing Address
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Address Line | 120 12TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2528
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Country | US
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Telephone | 320-763-4321
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Fax | 320-763-6921
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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 | 2725
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License Number State | MN
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