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DR. KERRY SCOT ANDERSON O.D.

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1851404628

Individual Registrant:
DR. KERRY SCOT ANDERSON O.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
14335 PIPELINE AVE  CHINO, CA 91710-5642 US
Tel: 909-628-8860  Fax: 909-628-6120

Contact information for business:
21078 JEWEL CT  DIAMOND BAR, CA 91765-4038 US
Tel: 909-628-8860  Fax: 909-628-6120

Registration Information:
NPI: 1851404628
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
CAOPT 9775 TPA

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
SD0097750CA05




HEALTH CARE JOBS CA - Page 1



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