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NPI Code Detail

MEDICARE: MARK D ANDERSON O.D.

MEDICARE: MARK D 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
1152W00000XOptometrist3906TGTX

General Provider Information

NPI Number : 1427021062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK D ANDERSON O.D.
Provider Business Mailing Address
First Line : 25 N MAIN ST
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3710
Country : US
Telephone Number : 281-361-2020
Fax Number : 281-361-0702
Provider Business Practice Location Address
First Line : 25 N MAIN ST
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3710
Country : US
Telephone Number : 281-361-2020
Fax Number : 281-361-0702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 08/04/2009

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