Provider Demographics
NPI:1629711759
Name:ANDERSON, RODNEY L (RT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11360 N 112TH DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1508
Mailing Address - Country:US
Mailing Address - Phone:623-466-2543
Mailing Address - Fax:
Practice Address - Street 1:11360 N 112TH DR
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1508
Practice Address - Country:US
Practice Address - Phone:623-466-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist