Provider Demographics
NPI:1487645974
Name:CIAMBRONE, ANDREW JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:CIAMBRONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3841 STRAFFORD PL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2471
Mailing Address - Country:US
Mailing Address - Phone:863-670-0109
Mailing Address - Fax:407-397-9231
Practice Address - Street 1:4444 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5315
Practice Address - Country:US
Practice Address - Phone:407-390-0585
Practice Address - Fax:407-397-9231
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20897ZMedicare PIN
U79642Medicare UPIN