Provider Demographics
NPI:1851383384
Name:ANDROS-ANDRZEJEWSKA, WIESLAWA (OD)
Entity Type:Individual
Prefix:DR
First Name:WIESLAWA
Middle Name:
Last Name:ANDROS-ANDRZEJEWSKA
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 1:1343 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1437
Mailing Address - Country:US
Mailing Address - Phone:210-533-0101
Mailing Address - Fax:210-533-9292
Practice Address - Street 1:1343 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1437
Practice Address - Country:US
Practice Address - Phone:210-533-0101
Practice Address - Fax:210-533-9292
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4768T152W00000X
OH5443152W00000X
OHT2355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU43532Medicare UPIN
TXG000E8954Medicare ID - Type Unspecified