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Organization

ANDERSON PROFESSIONAL EYECARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BENJAMIN DUNCAN ANDERSON LDO (OWNER LICENSED DISPENSING OPTICIAN)
(912) 748-3937
Entity
Organization

Contact information

Practice address
412 US HIGHWAY 80 SW, POOLER, GA 31322-2541
(912) 748-3937
(912) 748-6758
Mailing address
412 US HIGHWAY 80 SW, POOLER, GA 31322-2541
(912) 748-3937
(912) 748-6758

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1696
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
670525139A
GA
Enumeration date
05/08/2007
Last updated
05/25/2010
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