Provider Demographics
NPI:1730637844
Name:JUAREZ, ANDRE (OD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:JUAREZ
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 1:7718 W BOCA RATON RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4690
Mailing Address - Country:US
Mailing Address - Phone:760-234-6972
Mailing Address - Fax:
Practice Address - Street 1:13856 W WADDELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-3801
Practice Address - Country:US
Practice Address - Phone:623-547-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist