Provider Demographics
NPI:1023192200
Name:ANDREWS, KEITH PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:PAUL
Last Name:ANDREWS
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 1:103 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4907
Mailing Address - Country:US
Mailing Address - Phone:781-324-4111
Mailing Address - Fax:781-397-8213
Practice Address - Street 1:103 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-397-8213
Practice Address - Fax:781-397-8213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16138OtherBCBS MA
MA0334944Medicaid
MA0334944Medicaid
MAU 68560Medicare UPIN