Provider Demographics
NPI:1093569840
Name:RICHARD L. ANDERSON, O.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD L. ANDERSON, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-483-6619
Mailing Address - Street 1:363 S A ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5804
Mailing Address - Country:US
Mailing Address - Phone:805-483-6619
Mailing Address - Fax:805-487-5359
Practice Address - Street 1:363 S A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5804
Practice Address - Country:US
Practice Address - Phone:805-483-6619
Practice Address - Fax:805-487-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty