Provider Demographics
NPI:1033311063
Name:ANDERSON, EMERY M SR
Entity Type:Individual
Prefix:MR
First Name:EMERY
Middle Name:M
Last Name:ANDERSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 DOWLEN RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5962
Mailing Address - Country:US
Mailing Address - Phone:409-833-3261
Mailing Address - Fax:409-866-6849
Practice Address - Street 1:229 DOWLEN RD STE 4A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5962
Practice Address - Country:US
Practice Address - Phone:409-833-3261
Practice Address - Fax:409-866-6849
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR1478156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7414560049OtherEIN
TX0873990001Medicare UPIN