Provider Demographics
NPI:1033195326
Name:PRITCHARD, ANDREW LEON (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEON
Last Name:PRITCHARD
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 1:525 JAMESTOWN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1751
Mailing Address - Country:US
Mailing Address - Phone:215-483-8444
Mailing Address - Fax:215-482-8456
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-483-8444
Practice Address - Fax:215-482-8456
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014563160001Medicaid
PA037242Medicare PIN
PAU41547Medicare UPIN