Provider Demographics
NPI:1255023685
Name:ANDERSON, ANTHONY DAVID JR (LDO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:LDO
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:DAVID
Other - Last Name:ANDERSON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LDO
Mailing Address - Street 1:315 FURR ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-9500
Mailing Address - Country:US
Mailing Address - Phone:434-447-2777
Mailing Address - Fax:434-447-2908
Practice Address - Street 1:315 FURR ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-9500
Practice Address - Country:US
Practice Address - Phone:434-447-2777
Practice Address - Fax:434-447-2908
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003190156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician