Provider Demographics
NPI:1467422543
Name:ANDERSON, DAVID (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:2807 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1903
Mailing Address - Country:US
Mailing Address - Phone:252-823-8295
Mailing Address - Fax:
Practice Address - Street 1:2807 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1903
Practice Address - Country:US
Practice Address - Phone:252-823-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC66234OtherMEDCOST
NC2251777OtherUNITED HEALTHCARE
NC09025OtherBCBS
NC410022128OtherRAILROAD MEDICARE
NC8909025Medicaid
NC66234OtherMEDCOST
NC09025OtherBCBS