Provider Demographics
NPI:1164819579
Name:ANDERSEN, AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16325 S ALLMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9067
Mailing Address - Country:US
Mailing Address - Phone:402-540-0017
Mailing Address - Fax:
Practice Address - Street 1:11121 W 95TH ST
Practice Address - Street 2:PROFESSIONAL EYECARE
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1824
Practice Address - Country:US
Practice Address - Phone:913-492-7728
Practice Address - Fax:913-492-5217
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39234207W00000X, 152WC0802X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management