Provider Demographics
NPI:1639699846
Name:ANDERSON, SHARI MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15160 FOLIAGE AVE # 180
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5916
Mailing Address - Country:US
Mailing Address - Phone:952-953-4151
Mailing Address - Fax:
Practice Address - Street 1:2480 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2699
Practice Address - Country:US
Practice Address - Phone:651-639-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist