Provider Demographics
NPI:1578600938
Name:KAISER, ANDREA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:KAISER
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 1:660 COLUMBUS AVE
Mailing Address - Street 2:3-3
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1909
Mailing Address - Country:US
Mailing Address - Phone:914-747-2000
Mailing Address - Fax:914-747-4032
Practice Address - Street 1:660 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1909
Practice Address - Country:US
Practice Address - Phone:914-747-2000
Practice Address - Fax:914-747-4032
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY5840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400038310Medicare PIN