Provider Demographics
NPI:1891985115
Name:WERNER, ANDREW JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:WERNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 32 RD. #3C
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7608
Mailing Address - Country:US
Mailing Address - Phone:970-434-8617
Mailing Address - Fax:970-434-8618
Practice Address - Street 1:590 32 RD. #3C
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7608
Practice Address - Country:US
Practice Address - Phone:970-434-8617
Practice Address - Fax:970-434-8618
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO301349Medicare PIN