MEDICARE: DR. BETTE L ANDERSON M.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	207W00000X	Ophthalmology Physician	BA0383757	IL
2	207W00000X	Ophthalmology Physician	036073436	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205022193	OTHER	IL	TRI-CARE
2	1032096	OTHER	IL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	960582	OTHER	IL	UNITED HEALTHCARE
5	301724	OTHER	IL	PERSONAL CARE

General Provider Information

NPI Number	:	1386612927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTE L ANDERSON M.D.

Provider Business Mailing Address
First Line	:	3015 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7674
Country	:	US
Telephone Number	:	217-355-7947
Fax Number	:	217-355-8047

Provider Business Practice Location Address
First Line	:	3015 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7674
Country	:	US
Telephone Number	:	217-355-7947
Fax Number	:	217-355-8047

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/28/2018

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