Provider Demographics
NPI:1962632372
Name:ANDERSON, LAURA ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:WOFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1524 EUREKA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2850
Mailing Address - Country:US
Mailing Address - Phone:916-783-7696
Mailing Address - Fax:916-783-4199
Practice Address - Street 1:1524 EUREKA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2850
Practice Address - Country:US
Practice Address - Phone:916-783-7696
Practice Address - Fax:916-783-4199
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13804OtherMEDICAL LICENSE
CA0361730002Medicare NSC
CA0361730001Medicare NSC
CA13804OtherMEDICAL LICENSE