Provider Demographics
NPI:1285676262
Name:ANDERSON, TERI D (OD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:D
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 1:800 S STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3202
Mailing Address - Country:US
Mailing Address - Phone:336-765-5788
Mailing Address - Fax:336-765-5584
Practice Address - Street 1:800 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3202
Practice Address - Country:US
Practice Address - Phone:336-765-5788
Practice Address - Fax:336-765-5584
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09263OtherBCBSNC PROVIDER ID
NC8909263Medicaid
NCU78075Medicare UPIN
NC8909263Medicaid