Provider Demographics
NPI:1851505366
Name:ANDREW W HOWARD, OD, PLLC
Entity Type:Organization
Organization Name:ANDREW W HOWARD, OD, PLLC
Other - Org Name:LAFOLLETTE EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-562-1531
Mailing Address - Street 1:2145 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3003
Mailing Address - Country:US
Mailing Address - Phone:423-562-1531
Mailing Address - Fax:423-562-1724
Practice Address - Street 1:2145 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3003
Practice Address - Country:US
Practice Address - Phone:423-562-1531
Practice Address - Fax:423-562-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945636Medicare ID - Type UnspecifiedMEDICARE GROUP #
TN4803120001Medicare NSC