Provider Demographics
NPI:1093832677
Name:ANDERSON, PAMELA KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1706
Mailing Address - Country:US
Mailing Address - Phone:508-755-6969
Mailing Address - Fax:508-620-0098
Practice Address - Street 1:25 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2751
Practice Address - Country:US
Practice Address - Phone:508-421-2010
Practice Address - Fax:508-756-8078
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist