Individual
MIRIAM LORRAINE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02626
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25420027
BLUECROSS BLUESHIELD OF KANSAS CITY
MO
01
—
P00096424
RAILROAD MEDICARE
MO
Enumeration date
02/07/2006
Last updated
10/26/2020
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