NPI Search for Physicians and Health Care Providers
DR. KERRY SCOT ANDERSON O.D.
>> Optometrist >> Eye and Vision Services ProvidersRegistrant 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:
Primary | Code | Category/Description | State | License Number |
---|
Y | 152W00000X | Eye and Vision Services Providers Optometrist
| CA | OPT 9775 TPA |
Legacy codes, insurance codes and state license numbers:
Issuer | Number | State | Type |
---|
| SD0097750 | CA | 05 |
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