Provider Demographics
NPI:1609875988
Name:ANDERSON, JULIE BAKER (OD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BAKER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 HAWK AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2281
Mailing Address - Country:US
Mailing Address - Phone:816-524-8900
Mailing Address - Fax:816-525-2042
Practice Address - Street 1:3804 SO. JACKSON ROAD, STE. #4
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-296-3060
Practice Address - Fax:956-296-3061
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9138TG152W00000X
MO2005023449152W00000X
KS1611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX379853001OtherMEDICAID
TXH08JD72401OtherBCBS
MO31912021OtherBCBS OF KANSAS CITY
T86458Medicare UPIN