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General NPI Number Information
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NPI Number | 1598864514
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Entity Type | Individual
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Provider Name | JEFF BRUCE ANDERSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1360 TOWN CENTRE DR
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City | EAGAN
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State | MN
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Zip | 55123
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Country | US
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Telephone | 651-686-7435
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Fax |
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Provider Business Mailing Address
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Address Line | 116 KRESTWOOD DRIVE
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City | BURNSVILLE
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State | MN
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Zip | 55337
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Country | US
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Telephone | 952-223-1270
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2956
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License Number State | MN
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