MEDICARE: DR. VALERIE RENEE ANDERSON O.D.

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	18003351	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154489177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALERIE RENEE ANDERSON O.D.

Provider Business Mailing Address
First Line	:	930 CHIPPEWA DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-4502
Country	:	US
Telephone Number	:	219-310-8912
Fax Number	:

Provider Business Practice Location Address
First Line	:	9270 WICKER AVE
Second Line	:	SUITE A
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8508
Country	:	US
Telephone Number	:	219-365-1227
Fax Number	:	219-365-1552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	12/31/2013

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