Provider Demographics
NPI:1700995800
Name:ANDERSON, STEVEN LAWRENCE (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LAWRENCE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 ASCENSION POINT DR
Mailing Address - Street 2:APT #317
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4282
Mailing Address - Country:US
Mailing Address - Phone:817-462-1661
Mailing Address - Fax:
Practice Address - Street 1:915 EAST RANDOL MILL RD.
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:817-462-1661
Practice Address - Fax:817-462-9599
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05089T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist