Provider Demographics
NPI:1588841233
Name:AMBROSE, ANDREW ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ANTHONY
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:12300 JEFFERSON AVE STE 126
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-0003
Practice Address - Country:US
Practice Address - Phone:757-249-4330
Practice Address - Fax:757-249-4303
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001730152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist