Active NPI
Jeffrey R Andersen, O.D.
- Optometrist
- Healdsburg, CA
National Provider Identifier
1366450686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT7408T
- Practice address
- 1310 Prentice Dr
Suite F
Healdsburg, CA 95448-3384 - Phone
- (707) 433-9475
- Fax
- (707) 499-2013
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT7408T | CA | Primary |
Addresses
Primary practice location
1310 Prentice Dr
Suite F
Healdsburg, CA 95448-3384
Mailing address
1310 Prentice Dr
Suite F
Healdsburg, CA 95448-3384
Phone (707) 433-9475
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPT7408T | Other | CA | OPTOMETRY LICENSE |
| ZZZ13801Z | Other | CA | PTAN |
| ZZZ42820Z | Other | CA | PTAN |
| ZZZ13802Z | Other | CA | GROUP PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT7408T | CA | MD | Optometrist |
| 7408 | CA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319587200000",
"number": "1366450686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 PRENTICE DR",
"address_2": "SUITE F",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954483384",
"telephone_number": "707-433-9475",
"fax_number": "707-499-2013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 PRENTICE DR",
"address_2": "SUITE F",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954483384",
"telephone_number": "707-433-9475",
"fax_number": "707-499-2013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "JEFFREY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2011-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT7408T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTOMETRY LICENSE",
"identifier": "OPT7408T",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "ZZZ13801Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "ZZZ42820Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP PTAN",
"identifier": "ZZZ13802Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Healdsburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.