Provider Demographics
NPI:1669460770
Name:ANDERSON, THOMAS JAMES (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
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 1:1425 BOYSON RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2339
Mailing Address - Country:US
Mailing Address - Phone:319-743-3937
Mailing Address - Fax:319-743-3944
Practice Address - Street 1:915 ROBINS SQUARE DR
Practice Address - Street 2:
Practice Address - City:ROBINS
Practice Address - State:IA
Practice Address - Zip Code:52328-9649
Practice Address - Country:US
Practice Address - Phone:319-294-8888
Practice Address - Fax:319-294-4299
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45824OtherWELLMARK BCBS OF IOWA
IAT80070Medicare UPIN
IA45824OtherWELLMARK BCBS OF IOWA