Provider Demographics
NPI:1609055664
Name:DR. ANDREW M. DODD LLC
Entity Type:Organization
Organization Name:DR. ANDREW M. DODD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-794-9700
Mailing Address - Street 1:2282 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-3040
Mailing Address - Country:US
Mailing Address - Phone:330-794-9700
Mailing Address - Fax:330-794-6791
Practice Address - Street 1:2282 NEWTON ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-3040
Practice Address - Country:US
Practice Address - Phone:330-794-9700
Practice Address - Fax:330-794-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
5302332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH41009108Medicare PIN
OHDR9372971Medicare PIN
OH6131940001Medicare NSC