Individual
DR. JEFFREY R ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1310 PRENTICE DR, SUITE F, HEALDSBURG, CA 95448-3384
(707) 433-9475
(707) 499-2013
Mailing address
1310 PRENTICE DR, SUITE F, HEALDSBURG, CA 95448-3384
(707) 433-9475
(707) 499-2013
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT7408T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT7408T
OPTOMETRY LICENSE
CA
01
—
ZZZ13801Z
PTAN
CA
01
—
ZZZ13802Z
GROUP PTAN
CA
01
—
ZZZ42820Z
PTAN
CA
Enumeration date
08/03/2006
Last updated
10/26/2011
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