Provider Demographics
NPI:1427344142
Name:ANDERSEN, CARTER KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:KEITH
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:455 N HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1573
Mailing Address - Country:US
Mailing Address - Phone:805-451-0961
Mailing Address - Fax:
Practice Address - Street 1:1 S MILPAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3305
Practice Address - Country:US
Practice Address - Phone:805-884-8465
Practice Address - Fax:805-884-8467
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist