Provider Demographics
NPI:1962746024
Name:STEVEN L. ANDERSON, PA
Entity type:Organization
Organization Name:STEVEN L. ANDERSON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-462-1661
Mailing Address - Street 1:1205 BEACONSFIELD LN
Mailing Address - Street 2:APT. 304
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5047
Mailing Address - Country:US
Mailing Address - Phone:817-462-1661
Mailing Address - Fax:817-462-9599
Practice Address - Street 1:915 E RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6017
Practice Address - Country:US
Practice Address - Phone:817-462-1661
Practice Address - Fax:817-462-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5089-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty