MEDICARE: W D ANDERSON MD PC

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	207W00000X	Ophthalmology Physician	15983	CO

General Provider Information

NPI Number	:	1750790333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W D ANDERSON MD PC

Provider Business Mailing Address
First Line	:	3910 S CAREFREE CIR STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3053
Country	:	US
Telephone Number	:	719-637-1416
Fax Number	:

Provider Business Practice Location Address
First Line	:	3910 S CAREFREE CIR STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3053
Country	:	US
Telephone Number	:	719-637-1416
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM DALE ANDERSON
Credential	:	MD
Telephone Number	:	719-637-1416

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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