MEDICARE: JAMES STANLEY 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	152W00000X	Optometrist	1637	MN

General Provider Information

NPI Number	:	1619964459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES STANLEY ANDERSON OD

Provider Business Mailing Address
First Line	:	16550 W 78TH ST
Second Line	:	SUITE A
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-4315
Country	:	US
Telephone Number	:	952-934-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	16550 W 78TH ST
Second Line	:	SUITE A
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-4315
Country	:	US
Telephone Number	:	952-934-6926
Fax Number	:	952-934-3402

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/01/2024

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