Provider Demographics
NPI:1104017912
Name:ANDREW R. SCHWICHTENBERG
Entity Type:Organization
Organization Name:ANDREW R. SCHWICHTENBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHWICHTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-283-4590
Mailing Address - Street 1:2829 E OAKLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1908
Mailing Address - Country:US
Mailing Address - Phone:423-283-4590
Mailing Address - Fax:423-283-0867
Practice Address - Street 1:2829 E OAKLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1908
Practice Address - Country:US
Practice Address - Phone:423-283-4590
Practice Address - Fax:423-283-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3597385Medicaid
TN3597385Medicaid
TN0138990001Medicare NSC
TN3597385Medicare PIN
DT7841Medicare PIN
410028934Medicare PIN