Provider Demographics
NPI:1720200249
Name:YOURICH, ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:YOURICH
Suffix:
Gender:M
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:ST MICHAEL
Mailing Address - State:PA
Mailing Address - Zip Code:15951
Mailing Address - Country:US
Mailing Address - Phone:814-495-4413
Mailing Address - Fax:
Practice Address - Street 1:3100 OAKLAND AVENUE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA0EG000504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015971180004Medicaid
PA53067OtherDAVIS VISION
PA893031OtherBLUE CROSS BLUE SHIELD CL
PA53067OtherDAVIS VISION