Provider Demographics
NPI:1629170113
Name:MCKENZIE, ANDREW JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:950 NORTH AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3259
Mailing Address - Country:US
Mailing Address - Phone:970-242-0222
Mailing Address - Fax:970-242-0281
Practice Address - Street 1:1144 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7641
Practice Address - Country:US
Practice Address - Phone:970-242-0222
Practice Address - Fax:970-242-0281
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00314654OtherRAILROAD MEDICARE
COP00314654OtherRAILROAD MEDICARE
CO5404370001Medicare NSC
COC802007Medicare PIN