Provider Demographics
NPI:1467185595
Name:PLAXCO, ANDREW PATRICK (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PATRICK
Last Name:PLAXCO
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 1:2924 EMERYWOOD PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3746
Mailing Address - Country:US
Mailing Address - Phone:804-330-9303
Mailing Address - Fax:804-330-9302
Practice Address - Street 1:2924 EMERYWOOD PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-3746
Practice Address - Country:US
Practice Address - Phone:804-330-9303
Practice Address - Fax:804-330-9302
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist