Provider Demographics
NPI:1659340206
Name:ANDERSON, HARRY F (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:F
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-0607
Mailing Address - Country:US
Mailing Address - Phone:304-927-5910
Mailing Address - Fax:304-927-5918
Practice Address - Street 1:227 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-0607
Practice Address - Country:US
Practice Address - Phone:304-927-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV680OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149292000Medicaid
WVAN9163082Medicare ID - Type Unspecified
WV0149292000Medicaid