Individual
DR. DAVID J ANDERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
555 W SOUTH ST, FREEPORT, IL 61032-6792
(815) 232-3057
Mailing address
555 W SOUTH ST, FREEPORT, IL 61032-6792
(815) 232-3057
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0154160237
SHOPKO
IL
Enumeration date
05/16/2006
Last updated
07/08/2007
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