MEDICARE: N.T. ANDERSON, O.D., P.A.

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	OPC 4291	FL

General Provider Information

NPI Number	:	1073848776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N.T. ANDERSON, O.D., P.A.

Provider Business Mailing Address
First Line	:	1269 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4174
Country	:	US
Telephone Number	:	727-623-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1269 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4174
Country	:	US
Telephone Number	:	727-623-9000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICHOLAS ANDERSON
Credential	:	O.D.
Telephone Number	:	727-623-9000

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	01/30/2013

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