Provider Demographics
NPI:1013135292
Name:PAUL B ANDERSON
Entity Type:Organization
Organization Name:PAUL B ANDERSON
Other - Org Name:DR. PAUL B. ANDERSON AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-652-6430
Mailing Address - Street 1:2656 ELLWOOD RD
Mailing Address - Street 2:LAWRENCE VILLAGE PLAZA
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-6282
Mailing Address - Country:US
Mailing Address - Phone:724-652-6430
Mailing Address - Fax:724-652-4552
Practice Address - Street 1:2656 ELLWOOD RD
Practice Address - Street 2:LAWRENCE VILLAGE PLAZA
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-6282
Practice Address - Country:US
Practice Address - Phone:724-652-6430
Practice Address - Fax:724-652-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU12215Medicare UPIN
PAAN515204Medicare ID - Type Unspecified
PAMO656619Medicare ID - Type Unspecified
PAU68326Medicare UPIN
PAU64226Medicare UPIN
PACO713627Medicare ID - Type Unspecified