MEDICARE: CHAD W. ANDERSON, M.D., P.C.

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	290405-1205	UT

General Provider Information

NPI Number	:	1841310166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD W. ANDERSON, M.D., P.C.

Provider Business Mailing Address
First Line	:	1811 W ROYAL HUNTE DR STE 1
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-8274
Country	:	US
Telephone Number	:	435-586-1131
Fax Number	:	435-865-1121

Provider Business Practice Location Address
First Line	:	1811 W ROYAL HUNTE DR STE 1
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-8274
Country	:	US
Telephone Number	:	435-586-1131
Fax Number	:	435-865-1121

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CHAD W. ANDERSON
Credential	:	M.D.
Telephone Number	:	435-586-1131

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	12/02/2008

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