Provider Demographics
NPI:1417008327
Name:LENOIR, ANDRE TERRELL (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:TERRELL
Last Name:LENOIR
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 1:2788 BAYARD ST
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3441
Mailing Address - Country:US
Mailing Address - Phone:770-593-0046
Mailing Address - Fax:770-808-2787
Practice Address - Street 1:2788 BAYARD ST
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3441
Practice Address - Country:US
Practice Address - Phone:770-593-0046
Practice Address - Fax:770-808-2787
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2176152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA69118107AMedicaid
GA69118107AMedicaid
GA41ZCFWDMedicare PIN
GAGRP7236Medicare PIN