Provider Demographics
NPI:1538154588
Name:ANDERSON, DANIEL J (OD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
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 1:1470 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3065
Mailing Address - Country:US
Mailing Address - Phone:814-231-8195
Mailing Address - Fax:814-231-0726
Practice Address - Street 1:1470 MARTIN STREET
Practice Address - Street 2:ADVANCED EYE CARE SERVICES
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-231-3937
Practice Address - Fax:814-231-0726
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1310400001Medicare NSC
562419Medicare PIN
U10845Medicare UPIN