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General NPI Number Information
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NPI Number | 1275939621
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Entity Type | Organization
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Legal Business Name | DR. JILL ANDERSON & ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 422 N MAIN ST
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City | OSHKOSH
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State | WI
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Zip | 54901-4924
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Country | US
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Telephone | 920-235-8500
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Fax | 920-303-5547
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Provider Business Mailing Address
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Address Line | 422 N MAIN ST
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City | OSHKOSH
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State | WI
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Zip | 54901-4924
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Country | US
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Telephone | 920-235-8500
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Fax | 920-303-5547
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JILL ANN ANDERSON
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Credential | OD
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Telephone | 715-340-0496
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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 | 2651
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License Number State | WI
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