Provider Demographics
NPI:1164673844
Name:ITEGHIE, ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ITEGHIE
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 1:1042 CAMELLIA BLVD
Mailing Address - Street 2:# 3405
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6680
Mailing Address - Country:US
Mailing Address - Phone:404-422-0539
Mailing Address - Fax:337-984-8412
Practice Address - Street 1:3505 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5130
Practice Address - Country:US
Practice Address - Phone:337-984-1488
Practice Address - Fax:337-984-8412
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1566-598T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist