Provider Demographics
NPI:1174585996
Name:SMITH, ANDREW PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:SMITH
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 1:2036 GUYANOGA RD
Mailing Address - Street 2:PO BOX 690
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9217
Mailing Address - Country:US
Mailing Address - Phone:315-536-9923
Mailing Address - Fax:
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1284
Practice Address - Country:US
Practice Address - Phone:315-536-9941
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005146-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist