Provider Demographics
NPI:1073824629
Name:RADTKE, ANDREA CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:RADTKE
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 1:7560 W LAKE MEAD BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1050
Mailing Address - Country:US
Mailing Address - Phone:702-654-2020
Mailing Address - Fax:702-360-4087
Practice Address - Street 1:7560 W LAKE MEAD BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1050
Practice Address - Country:US
Practice Address - Phone:702-654-2020
Practice Address - Fax:702-360-4087
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37415Medicare PIN
NVEN275AMedicare PIN