Individual
MRS. PATRICIA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2003 COMMERCE DR, KINGSLAND, GA 31548-6767
(912) 882-3040
(912) 882-3786
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002807
GA
152WL0500X
Low Vision Rehabilitation Optometrist
WY222T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003150919A
—
GA
Enumeration date
10/15/2007
Last updated
09/27/2014
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