Active NPI
Jeffrey B Anderson, O.D.
- Optometrist
- Montevideo, MN
National Provider Identifier
1619964855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1614
- Practice address
- 602 Legion Dr
Montevideo, MN 56265-1709 - Phone
- (320) 269-8182
- Fax
- (320) 269-5868
- NPI assigned
- Oct 3, 2005
- Last updated
- Dec 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 1614 | MN | Primary |
Addresses
Primary practice location
602 Legion Dr
Montevideo, MN 56265-1709
Mailing address
PO Box 188
Montevideo, MN 56265-0188
Phone (320) 269-8182
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2214650 | Other | MEDICA | |
| 419000354 | Other | UNICARE | |
| 715581024800 | Other | MN | PREFERRED ONE |
| HP21877 | Other | HEALTH PARTNERS | |
| 419000354 | Other | HUMANA | |
| 334723100 | Medicaid | MN | |
| 5C004AN | Other | MN | BCBS OPTICAL ONLY |
| 44020AN | Other | MN | BLUE CROSS AND BLUE SHIEL |
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 |
|---|---|---|---|
| 1614 | MN | MD | Genetic Counselor (M.S.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325116800000",
"number": "1619964855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 188",
"city": "MONTEVIDEO",
"state": "MN",
"postal_code": "562650188",
"telephone_number": "320-269-8182",
"fax_number": "320-269-5868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 LEGION DR",
"city": "MONTEVIDEO",
"state": "MN",
"postal_code": "562651709",
"telephone_number": "320-269-8182",
"fax_number": "320-269-5868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JEFFREY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2011-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1614",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2214650",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNICARE",
"identifier": "419000354",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "715581024800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP21877",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "419000354",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "334723100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OPTICAL ONLY",
"identifier": "5C004AN",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIEL",
"identifier": "44020AN",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montevideo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.