Provider Demographics
NPI:1356033047
Name:ANDERSON, ANNA MICHELE (ABOC)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MICHELE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 FM 78
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1043
Mailing Address - Country:US
Mailing Address - Phone:210-666-6532
Mailing Address - Fax:210-666-6541
Practice Address - Street 1:8315 FM 78
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1043
Practice Address - Country:US
Practice Address - Phone:210-666-6532
Practice Address - Fax:210-666-6541
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier