Individual
DR. RICK D ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D, F.A.A.O.
Contact information
Practice address
1421 WASHINGTON AVE, RACINE, WI 53403-2254
(262) 637-7494
Mailing address
1421 WASHINGTON AVE, RACINE, WI 53403-2254
(262) 637-7494
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1567
WI
152WP0200X
Pediatric Optometrist
1567
WI
152WV0400X
Vision Therapy Optometrist
1567
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38594700
—
WI
Enumeration date
11/22/2005
Last updated
12/16/2008
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