Provider Demographics
NPI:1346215068
Name:ANDERSON OPTICAL, INC
Entity Type:Organization
Organization Name:ANDERSON OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:WOSCHITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-640-4782
Mailing Address - Street 1:1226 FAWN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-9787
Mailing Address - Country:US
Mailing Address - Phone:765-649-0908
Mailing Address - Fax:
Practice Address - Street 1:1931 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4206
Practice Address - Country:US
Practice Address - Phone:765-640-4782
Practice Address - Fax:765-644-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0356640001Medicare ID - Type Unspecified