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NPI Code Detail

MEDICARE: DR. PAUL B ANDERSON O.D.

MEDICARE: DR. PAUL B 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
1152W00000XOptometristOEG000349PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AN515204OTHERPABC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31507182OTHERPAGATEWAY
40016673OTHERPADORAL
52077435OTHERPAAETNA
63831-000OTHERPADAVIS
7919156OTHERPAEYEMED
8NC251826952-2A11OTHERPAANTHEM

General Provider Information

NPI Number : 1588741318
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL B ANDERSON O.D.
Provider Business Mailing Address
First Line : 101 CLEARVIEW CIR
Second Line : 500
City : BUTLER
State : PA
Zip : 16001-1576
Country : US
Telephone Number : 724-283-7424
Fax Number : 724-282-1929
Provider Business Practice Location Address
First Line : 101 CLEARVIEW CIR
Second Line : 500
City : BUTLER
State : PA
Zip : 16001-1576
Country : US
Telephone Number : 724-283-7424
Fax Number : 724-282-1929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 02/06/2024

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