Provider Demographics
NPI:1689689101
Name:BUZZELLI, ANDREW R (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:BUZZELLI
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:147 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-9118
Mailing Address - Country:US
Mailing Address - Phone:606-218-5511
Mailing Address - Fax:606-218-5509
Practice Address - Street 1:147 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-9118
Practice Address - Country:US
Practice Address - Phone:606-218-5511
Practice Address - Fax:606-218-5509
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ27OA00340800152W00000X
KYKY1973DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist