K. Michael Anderson,O.D.,P.C.
Organization Active NPI Optometrist · Montevallo, AL
NPI 1255426342 · NPPES record last updated Jun 24, 2009
Key facts
- NPI
- 1255426342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- K. MICHAEL ANDERSON,O.D.,P.C.
- Practice address
- 977 Main St
Montevallo, AL 35115-3847 - Phone
- (205) 665-1488
- Fax
- (205) 665-5128
- NPI assigned
- Oct 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Kenneth Michael Anderson, O.D.
- Title
- Owner
- Phone
- (205) 665-1488
Practitioners 1
-
Kenneth Michael Anderson, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061227000073 | AL | Part B Supplier - Clinic/Group Practice | 5395745285 |
Receives reassigned benefits from 1 practitioner Practice locations: Montevallo, AL |
National Provider Directory
Locations
977 Main St
Montevallo, AL 35115
Phone (205) 665-1488
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
977 Main St
Montevallo, AL 35115-3847
Mailing address
977 Main St
Montevallo, AL 35115-3847
Phone (205) 665-1488
Other providers in Montevallo, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.