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General NPI Number Information
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NPI Number | 1770611477
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Entity Type | Organization
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Legal Business Name | JEFFREY L. ANDERSON, O.D.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 1608 1ST ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-0318
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Country | US
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Telephone | 507-282-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 1ST ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-0318
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Country | US
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Telephone | 507-282-7121
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. JEFFREY LEON ANDERSON
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Credential | O.D.
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Telephone | 507-282-7121
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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 | 2665
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License Number State | MN
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