Provider Demographics
NPI:1578626628
Name:ANDERSON, ALAN E (OD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9905 45TH AVENUE NORTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-3315
Mailing Address - Country:US
Mailing Address - Phone:763-595-8414
Mailing Address - Fax:763-595-8438
Practice Address - Street 1:9905 45TH AVENUE NORTH
Practice Address - Street 2:SUITE 110
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-3315
Practice Address - Country:US
Practice Address - Phone:763-595-8414
Practice Address - Fax:763-595-8414
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117109OtherUCARE MN
MN2499537OtherMETROPOLITAN HEALTH PLAN
MN018023800Medicaid
MN2200080OtherMEDICA PRIMARY
MN51D66ANOtherBLUE CROSS BLUE SHIELD
MN2201446OtherMEDICA CHOICE
MN23979OtherHEALTH PARTNERS
MN410046879OtherRAILROAD MEDICARE
MN51D66ANOtherBLUE CROSS BLUE SHIELD
MN2499537OtherMETROPOLITAN HEALTH PLAN