Provider Demographics
NPI:1366690299
Name:ROGER A ANDERSON O.D. P.C.
Entity Type:Organization
Organization Name:ROGER A ANDERSON O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-488-2705
Mailing Address - Street 1:1405 4TH ST SW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3515
Mailing Address - Country:US
Mailing Address - Phone:406-488-2705
Mailing Address - Fax:406-488-2713
Practice Address - Street 1:1405 4TH ST SW
Practice Address - Street 2:SUITE 2
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3515
Practice Address - Country:US
Practice Address - Phone:406-488-2705
Practice Address - Fax:406-488-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty