Basic Information
| Provider Information | |||||||||
| NPI: | 1760487227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S ELISEO DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949042152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154618200 | ||||||||
| FaxNumber: | 4154614627 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 S ELISEO DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949042152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154618200 | ||||||||
| FaxNumber: | 4154614627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 10/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 00G305540 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 00G305540 | 05 | CA | MEDICAID | 7SG181668 | 01 | RAILROAD MEDICARE | OTHER |