Active NPI
Roger Allan Anderson, OD
- Optometrist
- Sidney, MT
National Provider Identifier
1740345776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 414
- Practice address
- 1405 4TH St SW
West Side Professional Center Ste 2
Sidney, MT 59270-3515 - Phone
- (406) 488-2705
- Fax
- (406) 488-2713
- NPI assigned
- Dec 27, 2006
- Last updated
- Jul 8, 2007
- 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 | 414 | MT | Primary |
Addresses
Primary practice location
1405 4TH St SW
West Side Professional Center Ste 2
Sidney, MT 59270-3515
Mailing address
1405 4TH St SW
Ste 2
Sidney, MT 59270-3515
Phone (406) 488-2705
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0480857 | Medicaid | MT | |
| 27110 | Other | MT | BLUE CROSS BLUE SHIELD |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances Mahon Deaconess Hospital | Past | Accepting new patients | |
| Sunrise Wellness Center, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Sidney, MT
- NPI 1366690299
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
-
- Community/Behavioral Health Agency
- Sidney, MT
- NPI 1962063396
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740345776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 4TH ST SW",
"address_2": "STE 2",
"city": "SIDNEY",
"state": "MT",
"postal_code": "592703515",
"telephone_number": "406-488-2705",
"fax_number": "406-488-2713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 4TH ST SW",
"address_2": "WEST SIDE PROFESSIONAL CENTER STE 2",
"city": "SIDNEY",
"state": "MT",
"postal_code": "592703515",
"telephone_number": "406-488-2705",
"fax_number": "406-488-2713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "ROGER",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "414",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0480857",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "27110",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sidney, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.