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Organization
ANDERSON PROFESSIONAL EYECARE LLC
Active
Organization
ANDERSON PROFESSIONAL EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN DUNCAN ANDERSON LDO (OWNER LICENSED DISPENSING OPTICIAN)
(912) 748-3937
Entity
Organization
Contact information
Practice address
412 US HIGHWAY 80 SW, POOLER, GA 31322-2541
(912) 748-3937
(912) 748-6758
Mailing address
412 US HIGHWAY 80 SW, POOLER, GA 31322-2541
(912) 748-3937
(912) 748-6758
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1696
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
670525139A
—
GA
Enumeration date
05/08/2007
Last updated
05/25/2010
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