Provider Demographics
NPI:1942252366
Name:ANDREJKO, PHYLLIS (OD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ANDREJKO
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 1:940 COMMONWEALTH AVE
Mailing Address - Street 2:NEW ENGLAND EYE INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-587-5511
Mailing Address - Fax:617-587-5512
Practice Address - Street 1:4199 WASHINGTON STREET, SUITE 2
Practice Address - Street 2:NEW ENGLAND EYE ROSLINDALE
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-587-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0708381Medicaid
152186OtherHARVARD PILGRIM HEALTH CA
MA467450OtherTUFTS HEALTH PLAN
AA119306OtherHARVARD PILGRIM
2008451OtherCIGNA
2500346OtherUNITED HEALTH CARE
MA4021OtherEYEMED
W16351OtherBLUE CROSS BLUE SHIELD OF
0018540OtherNHP
152186OtherHARVARD PILGRIM HEALTH CA
U85773Medicare UPIN