Provider Demographics
NPI:1033319272
Name:DOROTHY K. ANDERSON, O.D.
Entity Type:Organization
Organization Name:DOROTHY K. ANDERSON, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-348-2993
Mailing Address - Street 1:1670 BARATARIA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4354
Mailing Address - Country:US
Mailing Address - Phone:504-348-2993
Mailing Address - Fax:504-340-4468
Practice Address - Street 1:1670 BARATARIA BLVD STE D
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4354
Practice Address - Country:US
Practice Address - Phone:504-348-2993
Practice Address - Fax:504-340-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA729-176T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143456Medicaid
LA1143456Medicaid
LA48516Medicare PIN
LA0147240001Medicare NSC