Provider Demographics
NPI:1972787281
Name:FORTE, ANDREA (COA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FORTE
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Gender:F
Credentials:COA
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Mailing Address - Street 1:4001 GEIST RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3552
Mailing Address - Country:US
Mailing Address - Phone:907-479-0852
Mailing Address - Fax:907-479-0859
Practice Address - Street 1:4001 GEIST RD
Practice Address - Street 2:SUITE 9
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3552
Practice Address - Country:US
Practice Address - Phone:907-479-0852
Practice Address - Fax:907-479-0859
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
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Provider Licenses
StateLicense IDTaxonomies
AK152208156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant