Provider Demographics
NPI:1699818260
Name:ANDERSON, DAVID J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4350 E CAMELBACK RD
Mailing Address - Street 2:B 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2701
Mailing Address - Country:US
Mailing Address - Phone:602-279-5855
Mailing Address - Fax:602-926-8808
Practice Address - Street 1:4350 E CAMELBACK RD
Practice Address - Street 2:B 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2701
Practice Address - Country:US
Practice Address - Phone:602-279-5855
Practice Address - Fax:602-926-8808
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ 822152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1710245121OtherMEDICARE GROUP NPI