Provider Demographics
NPI:1063644201
Name:ANDREWS, MICHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:ANDREWS
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 1:4000 LUXOTTICA PL
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8114
Mailing Address - Country:US
Mailing Address - Phone:513-313-9216
Mailing Address - Fax:513-492-6772
Practice Address - Street 1:3781 BLOSSOM CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4119
Practice Address - Country:US
Practice Address - Phone:513-313-9216
Practice Address - Fax:513-492-6772
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008603152W00000X
NYT006828-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist