Provider Demographics
NPI:1124020441
Name:LEITZEL, ANDREW L (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:LEITZEL
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 1:234 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1023
Mailing Address - Country:US
Mailing Address - Phone:717-266-5661
Mailing Address - Fax:717-266-6510
Practice Address - Street 1:234 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1023
Practice Address - Country:US
Practice Address - Phone:717-266-5661
Practice Address - Fax:717-266-6510
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101057379Medicaid
082682K26Medicare ID - Type Unspecified
V01107Medicare UPIN