Provider Demographics
NPI:1366502106
Name:BLENDER, ANDREW C (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:BLENDER
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 1:412 S ALLEN ST
Mailing Address - Street 2:P.O. BOX 466
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5201
Mailing Address - Country:US
Mailing Address - Phone:814-234-1515
Mailing Address - Fax:
Practice Address - Street 1:412 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5201
Practice Address - Country:US
Practice Address - Phone:814-234-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000953152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU73722Medicare UPIN
PA133274Medicare PIN