Provider Demographics
NPI:1255426342
Name:K. MICHAEL ANDERSON,O.D.,P.C.
Entity type:Organization
Organization Name:K. MICHAEL ANDERSON,O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-665-1488
Mailing Address - Street 1:977 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-3847
Mailing Address - Country:US
Mailing Address - Phone:205-665-1488
Mailing Address - Fax:205-665-5128
Practice Address - Street 1:977 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-3847
Practice Address - Country:US
Practice Address - Phone:205-665-1488
Practice Address - Fax:205-665-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty