Provider Demographics
NPI:1558629923
Name:DEMOSTHENOUS, ANDRIA (OD)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:DEMOSTHENOUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 NORTHAMPTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1198
Mailing Address - Country:US
Mailing Address - Phone:413-527-9284
Mailing Address - Fax:413-527-8181
Practice Address - Street 1:250 NORTHAMPTON ST STE A
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1198
Practice Address - Country:US
Practice Address - Phone:413-527-9284
Practice Address - Fax:413-527-8181
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOPT5660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist