Provider Demographics
NPI:1467866509
Name:CONGDON, ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CONGDON
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 1:3000 CLEVELAND AVE
Mailing Address - Street 2:A
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-3760
Mailing Address - Country:US
Mailing Address - Phone:715-732-2101
Mailing Address - Fax:
Practice Address - Street 1:3003 CLEVELAND AVE
Practice Address - Street 2:A
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3760
Practice Address - Country:US
Practice Address - Phone:920-883-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3346-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist