Provider Demographics
NPI:1811373012
Name:ADEYEMI, ANDREA VANESSA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:VANESSA
Last Name:ADEYEMI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 COPPER MTN
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-6901
Mailing Address - Country:US
Mailing Address - Phone:678-361-5592
Mailing Address - Fax:
Practice Address - Street 1:1221 N BRAZOS ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2052
Practice Address - Country:US
Practice Address - Phone:254-694-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist