Individual
ANNA R ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
200 SW MARKET ST, #L120, PORTLAND, OR 97201-5715
(503) 223-8147
Mailing address
1 JEFFERSON PKWY, APT #328, LAKE OSWEGO, OR 97035-8847
(503) 387-6190
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
13504
CA
152W00000X
Optometrist
1697
AZ
152W00000X
Optometrist
Primary
3284AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
554653
—
AZ
Enumeration date
07/12/2008
Last updated
09/04/2014
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