MEDICARE: ANDERSON OPTOMETRIC ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265413587	OTHER	SC	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1710969969	OTHER		NPI

General Provider Information

NPI Number	:	1033190350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON OPTOMETRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 51096
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-2096
Country	:	US
Telephone Number	:	864-295-3550
Fax Number	:	864-295-3242

Provider Business Practice Location Address
First Line	:	3529 HIGHWAY 153
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7515
Country	:	US
Telephone Number	:	864-295-3550
Fax Number	:	864-295-3242

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARION K WILLIAMS
Credential	:	OPTOMETRIST
Telephone Number	:	864-295-3550

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/18/2011

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