MEDICARE: DR. DUSTIN CLARK 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	05890	TX
2	152W00000X	Optometrist	2952	CO

General Provider Information

NPI Number	:	1669442661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN CLARK ANDERSON O.D.

Provider Business Mailing Address
First Line	:	PO BOX 4654
Second Line	:
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-4654
Country	:	US
Telephone Number	:	970-453-2020
Fax Number	:	970-547-5865

Provider Business Practice Location Address
First Line	:	216 S MAIN ST
Second Line	:	STE 2
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424
Country	:	US
Telephone Number	:	970-453-2020
Fax Number	:	970-547-5865

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/12/2025

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