Provider Demographics
NPI:1598807927
Name:STAMM, ANDREA LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEIGH
Last Name:STAMM
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 1:524 SHEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7524
Mailing Address - Country:US
Mailing Address - Phone:859-263-7862
Mailing Address - Fax:
Practice Address - Street 1:116 MERIDIAN WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2876
Practice Address - Country:US
Practice Address - Phone:859-353-4053
Practice Address - Fax:859-624-9667
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1525DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000867Medicaid
KY000000353349OtherANTHEM BCBS
KY41889OtherSPECTERA
KY47976OtherDAVIS OR GUARDIAN VISION
KY35638OtherAVESIS
KY550702OtherNVA
KY41889OtherSPECTERA
KY35638OtherAVESIS