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General NPI Number Information
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NPI Number | 1366450686
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Entity Type | Individual
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Provider Name | JEFFREY R ANDERSEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 1310 PRENTICE DR SUITE F
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City | HEALDSBURG
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State | CA
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Zip | 95448-3384
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Country | US
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Telephone | 707-433-9475
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Fax | 707-499-2013
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Provider Business Mailing Address
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Address Line | 1310 PRENTICE DR SUITE F
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City | HEALDSBURG
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State | CA
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Zip | 95448-3384
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Country | US
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Telephone | 707-433-9475
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Fax | 707-499-2013
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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 | OPT7408T
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License Number State | CA
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