Individual
MITCHEL RYAN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1700 CERRILLOS RD, SANTA FE, NM 87505-3026
(505) 988-9821
Mailing address
2949 CAMINO PIEDRA LUMBRE, SANTA FE, NM 87505-5379
(435) 851-9281
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11323320-9934
UT
Other
Enumeration date
06/26/2019
Last updated
06/26/2019
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