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General NPI Number Information
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NPI Number | 1750398145
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Entity Type | Individual
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Provider Name | MATTHEW JAMES ANDERSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 50 VETERANS WAY
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684
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Country | US
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Telephone | 423-926-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 VILLA CT
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City | JOHNSON CITY
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State | TN
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Zip | 37615-4590
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Country | US
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Telephone | 231-690-1370
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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 | 2479
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004372
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License Number State | MI
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