MEDICARE: DR. NICHOLAS 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	OPC 4291	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPC4291	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689909442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ANDERSON O.D.

Provider Business Mailing Address
First Line	:	1269 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4174
Country	:	US
Telephone Number	:	727-623-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1269 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4174
Country	:	US
Telephone Number	:	727-623-9000
Fax Number	:

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

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	03/04/2026

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