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NPI Code Detail

MEDICARE: CLINTON R ANDERSON O.D.

MEDICARE:   CLINTON R 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
1152W00000XOptometristOPC3205FL
2152W00000XOptometrist2505TOR

Other Identifiers

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

General Provider Information

NPI Number : 1326034349
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLINTON R ANDERSON O.D.
Provider Business Mailing Address
First Line : 1507 WATER TERRACE LN
Second Line :
City : BRANDON
State : FL
Zip : 33511-1269
Country : US
Telephone Number : 813-597-4540
Fax Number :
Provider Business Practice Location Address
First Line : 2830 N HIAWASSEE RD
Second Line :
City : ORLANDO
State : FL
Zip : 32818-3319
Country : US
Telephone Number : 407-296-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 03/17/2018

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