Provider Demographics
NPI:1477993590
Name:ANDERSEN, COURTNEY ERIN (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ERIN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ERIN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:VA MEDICAL CENTER EYE CLINIC
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:VA MEDICAL CENTER EYE CLINIC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist