MEDICARE: BENJAMIN F ANDERSON JR OD PA

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	OPC 3866	FL

General Provider Information

NPI Number	:	1669786539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN F ANDERSON JR OD PA

Provider Business Mailing Address
First Line	:	351 N CONGRESS AVE
Second Line	:	STE 174
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3415
Country	:	US
Telephone Number	:	954-599-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	5062 W ATLANTIC AVE
Second Line	:	GOLDEN EYE & EAR
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8129
Country	:	US
Telephone Number	:	561-498-8884
Fax Number	:	561-498-7878

Authorized Official
Title or Position	:	CEO
Name	:	DR. BEN F ANDERSON JR.
Credential	:	O.D.
Telephone Number	:	954-599-1188

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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