Provider Demographics
NPI:1386612927
Name:ANDERSON, BETTE L (MD)
Entity type:Individual
Prefix:DR
First Name:BETTE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 VILLAGE OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7674
Mailing Address - Country:US
Mailing Address - Phone:217-355-7947
Mailing Address - Fax:217-355-8047
Practice Address - Street 1:3015 VILLAGE OFFICE PL
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7674
Practice Address - Country:US
Practice Address - Phone:217-355-7947
Practice Address - Fax:217-355-8047
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBA0383757207W00000X
IL036073436207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205022193OtherTRI-CARE
IL1032096OtherBLUE CROSS BLUE SHIELD
IL036073436Medicaid
IL960582OtherUNITED HEALTHCARE
IL301724OtherPERSONAL CARE
IL214499Medicare ID - Type UnspecifiedMEDICARE