Provider Demographics
NPI:1033419460
Name:GANESH, ANDREW KUMAR (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KUMAR
Last Name:GANESH
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 1:8451 PICARDY AVE.
Mailing Address - Street 2:UNIT 2218
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:202-302-0883
Mailing Address - Fax:
Practice Address - Street 1:7515 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4700
Practice Address - Country:US
Practice Address - Phone:225-924-5460
Practice Address - Fax:225-924-0988
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1947-883AT152W00000X
VA0618001942152W00000X
MDTA2204152W00000X
CA15402 TLG152W00000X
NJ27OA00683300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04339000Medicaid