Provider Demographics
NPI:1497838932
Name:ANDERSON, SCOTT TYLER (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:TYLER
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 1:24351 AVENIDA DE LA CARLOTA
Mailing Address - Street 2:SUITE N-3
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3656
Mailing Address - Country:US
Mailing Address - Phone:949-768-4601
Mailing Address - Fax:949-768-7582
Practice Address - Street 1:24351 AVENIDA DE LA CARLOTA
Practice Address - Street 2:SUITE N-3
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3656
Practice Address - Country:US
Practice Address - Phone:949-768-4601
Practice Address - Fax:949-768-7582
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10279 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist