Provider Demographics
NPI:1407143175
Name:BIONDO, ANDREW JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:BIONDO
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 1:200S KIRKWOOD RD 100
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4335
Mailing Address - Country:US
Mailing Address - Phone:314-394-3045
Mailing Address - Fax:314-394-3049
Practice Address - Street 1:200S KIRKWOOD RD 100
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4335
Practice Address - Country:US
Practice Address - Phone:314-394-3045
Practice Address - Fax:314-394-3049
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist