Provider Demographics
NPI:1679659593
Name:ANDERSON, DOROTHY K (OD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:K
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 1:1670 BARATARIA BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4354
Mailing Address - Country:US
Mailing Address - Phone:504-348-2993
Mailing Address - Fax:504-340-4468
Practice Address - Street 1:1670 BARATARIA BLVD
Practice Address - Street 2:STE D
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4354
Practice Address - Country:US
Practice Address - Phone:504-348-2993
Practice Address - Fax:504-340-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7291761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143456Medicaid
LA0147240001Medicare NSC
LA1143456Medicaid
LA48516Medicare PIN