Provider Demographics
NPI:1861683781
Name:COSTELLO, ANDREW B (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2126 ABBOTT MARTIN RD STE 142
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2609
Mailing Address - Country:US
Mailing Address - Phone:615-626-2988
Mailing Address - Fax:615-523-1690
Practice Address - Street 1:2126 ABBOTT MARTIN RD STE 142
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2609
Practice Address - Country:US
Practice Address - Phone:615-626-2988
Practice Address - Fax:615-523-1690
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002327152W00000X
TN2727152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist