Anderson Eye Care, LLC – Optometrist

Key facts

NPI: 1801064837
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
Legal business name: ANDERSON EYE CARE, LLC
Practice address: 55 Campau Ave NW
Riverfront Plaza BLDG-Suite #10
Grand Rapids, MI 49503-2642
Phone: (616) 459-7380
Fax: (616) 459-5752
NPI assigned: Feb 12, 2008
Organization subpart: No

Authorized official

Name: Dr. Gary A Anderson, O.D.
Title: Owner
Phone: (616) 459-7380

National Provider Directory

Locations

55 Campau Ave NW
Ste 10
Grand Rapids, MI 49503
Phone (616) 459-7380

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X SINGLE SPECIALTY GROUP	152W00000X			Yes

Addresses

Primary practice location

55 Campau Ave NW
Riverfront Plaza BLDG-Suite #10
Grand Rapids, MI 49503-2642

Mailing address

55 Campau Ave NW
Riverfront Plaza BLDG-Suite #10
Grand Rapids, MI 49503-2642
Phone (616) 459-7380

Other identifiers

Identifier	Type	State	Issuer
900D120690	Other	MI	BLUE CROSS BLUE SHIELD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 11, 2010.

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265846400000",
    "number": "1801064837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 CAMPAU AVE NW",
            "address_2": "RIVERFRONT PLAZA BLDG-SUITE #10",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032642",
            "telephone_number": "616-459-7380",
            "fax_number": "616-459-5752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 CAMPAU AVE NW",
            "address_2": "RIVERFRONT PLAZA BLDG-SUITE #10",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032642",
            "telephone_number": "616-459-7380",
            "fax_number": "616-459-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2010-02-11",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-459-7380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900D120690",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

All providers in Grand Rapids, MI · Optometrist in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.