Provider Demographics
NPI:1326488008
Name:ANDERSON, MATTHEW K (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3049
Mailing Address - Country:US
Mailing Address - Phone:651-333-4420
Mailing Address - Fax:651-204-0966
Practice Address - Street 1:506 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-333-4420
Practice Address - Fax:651-204-0966
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist