MEDICARE: DR. KEVIN JOHN ANDERSON OD

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	152WC0802X	Corneal and Contact Management Optometrist	CO1342	CO
2	152WX0102X	Occupational Vision Optometrist	CO1342	CO

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	:	1447239736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JOHN ANDERSON OD

Provider Business Mailing Address
First Line	:	4103 BOARDWALK STE 100
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-223-0592
Fax Number	:	970-377-1082

Provider Business Practice Location Address
First Line	:	4103 BOARDWALK STE 100
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-223-0592
Fax Number	:	970-377-1082

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	01/12/2011

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Directions to “ DR. KEVIN JOHN ANDERSON OD” Practice Location

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