Individual
DR. GARY ALFRED ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
55 CAMPAU AVE NW, RIVERFRONT PLAZA BLDG SUITE 10, GRAND RAPIDS, MI 49503-2642
(616) 459-7380
(616) 459-5752
Mailing address
55 CAMPAU AVE NW, RIVERFRONT PLAZA BLDG SUITE 10, GRAND RAPIDS, MI 49503-2642
(616) 459-7380
(616) 459-5752
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002731
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900D114640
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/31/2006
Last updated
02/11/2010
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