Provider Demographics
NPI:1205016508
Name:ANDERSON PERFECT VISION OPTICAL INC.
Entity Type:Organization
Organization Name:ANDERSON PERFECT VISION OPTICAL INC.
Other - Org Name:EYEWEAR DIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:972-370-2043
Mailing Address - Street 1:4300 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2802
Mailing Address - Country:US
Mailing Address - Phone:972-370-2043
Mailing Address - Fax:972-370-2029
Practice Address - Street 1:4300 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2802
Practice Address - Country:US
Practice Address - Phone:972-370-2043
Practice Address - Fax:972-370-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service