Provider Demographics
NPI:1073869293
Name:DEMERITT, ANDREW PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:DEMERITT
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 1:122 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2827
Mailing Address - Country:US
Mailing Address - Phone:989-720-2020
Mailing Address - Fax:
Practice Address - Street 1:122 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2827
Practice Address - Country:US
Practice Address - Phone:989-720-2020
Practice Address - Fax:929-720-2023
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004702152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier