Provider Demographics
NPI:1851584767
Name:PIKKULA, ANDREA K (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:K
Last Name:PIKKULA
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 1:2770 N UNION BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1120
Mailing Address - Country:US
Mailing Address - Phone:719-471-2020
Mailing Address - Fax:
Practice Address - Street 1:2770 N UNION BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1120
Practice Address - Country:US
Practice Address - Phone:719-471-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100604Medicare PIN