Provider Demographics
NPI:1417033069
Name:HAWARI, ANDY MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:MARK
Last Name:HAWARI
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-0547
Mailing Address - Country:US
Mailing Address - Phone:903-569-5432
Mailing Address - Fax:903-569-2994
Practice Address - Street 1:1238 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1002
Practice Address - Country:US
Practice Address - Phone:903-569-5432
Practice Address - Fax:903-569-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04091TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG7745OtherRAILROAD MEDICARE
TX89G671OtherBLUE CROSS BLUE SHIELD
TX89G671Medicare PIN
TXCG7745OtherRAILROAD MEDICARE
TX0242130001Medicare NSC