Provider Demographics
NPI:1174836548
Name:ANDRZEJEWSKI, TIFFANY M (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:ANDRZEJEWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 CENTRAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5613
Mailing Address - Country:US
Mailing Address - Phone:847-432-6010
Mailing Address - Fax:847-432-8241
Practice Address - Street 1:806 CENTRAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-432-6010
Practice Address - Fax:847-432-8241
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010521152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL594770001Medicare PIN