Provider Demographics
NPI:1912218660
Name:PAUL E ANDERSON, OD, PA
Entity Type:Organization
Organization Name:PAUL E ANDERSON, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-867-1888
Mailing Address - Street 1:600 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0200
Mailing Address - Country:US
Mailing Address - Phone:352-867-1888
Mailing Address - Fax:352-867-5652
Practice Address - Street 1:600 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0200
Practice Address - Country:US
Practice Address - Phone:352-867-1888
Practice Address - Fax:352-867-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620636100Medicaid
FL20161Medicare UPIN