MEDICARE: JEFFREY L. 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	2665	MN

General Provider Information

NPI Number	:	1437287554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY L. ANDERSON O.D.

Provider Business Mailing Address
First Line	:	300 2ND AVE NW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3165
Country	:	US
Telephone Number	:	507-437-3227
Fax Number	:	507-437-8070

Provider Business Practice Location Address
First Line	:	300 2ND AVE NW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3165
Country	:	US
Telephone Number	:	507-437-3227
Fax Number	:	507-437-8070

Authorized Official
Title or Position	:	OWNER OPTOMETRIST
Name	:	DR. JEFFREY LEON ANDERSON
Credential	:	O.D.
Telephone Number	:	507-437-3227

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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