Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2747 | CO |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2747 | CO |
NPI | 1306179031 |
---|---|
Provider Name | Dr. Travis Anderson |
First Address | Denver, CO 80210 |
Second Address | Grand Junction, CO 81501-8180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2009 |
Last Update Date | 21/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07920865 | (05) | CO |