Provider Demographics
NPI:1427044916
Name:ANDERSON, JEFFREY L (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4645
Mailing Address - Country:US
Mailing Address - Phone:507-437-3227
Mailing Address - Fax:507-437-8070
Practice Address - Street 1:200 14TH ST NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4645
Practice Address - Country:US
Practice Address - Phone:507-437-3227
Practice Address - Fax:507-437-8070
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1021763OtherPREFERRED ONE
MN6C465ANOtherBLUE CROSS BLUE SHIELD
MN09Y96LIOtherBLUE CROSS BLUE SHIELD
MN09Y97ANOtherBLUE CROSS BLUE SHIELD
22-00464OtherMEDICA
58381OtherHEALTH PARTNERS
MN39797WEOtherBLUE CROSS BLUE SHIELD
MN96Z70ANOtherBLUE CROSS BLUE SHIELD
09597ANOtherBLUE PLUS
MN143214OtherU-CARE
MN09Y99LIOtherBLUE CROSS BLUE SHIELD
MN6C464ANOtherBLUE CROSS BLUE SHIELD
MN411898525OtherHUMANA
MN605K3LIOtherBLUE CROSS BLUE SHIELD
MN031217700Medicaid
MN09Y99LIOtherBLUE CROSS BLUE SHIELD
MN96Z70ANOtherBLUE CROSS BLUE SHIELD
1021763OtherPREFERRED ONE
MN09Y97ANOtherBLUE CROSS BLUE SHIELD