Provider Demographics
NPI:1720681265
Name:DR KEVIN ANDERSON & ASSOCIATES, PC.
Entity Type:Organization
Organization Name:DR KEVIN ANDERSON & ASSOCIATES, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-223-0592
Mailing Address - Street 1:4103 BOARDWALK DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5933
Mailing Address - Country:US
Mailing Address - Phone:970-223-0592
Mailing Address - Fax:970-377-1082
Practice Address - Street 1:4252 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4130
Practice Address - Country:US
Practice Address - Phone:303-690-1696
Practice Address - Fax:970-377-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000139868Medicaid