Provider Demographics
NPI:1134435225
Name:NEEDHAM, ANDREA M (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:NEEDHAM
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 1:2 S SILVER ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1469
Mailing Address - Country:US
Mailing Address - Phone:913-951-7696
Mailing Address - Fax:
Practice Address - Street 1:2 S SILVER ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1469
Practice Address - Country:US
Practice Address - Phone:913-951-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200912130Medicaid
KS022375017Medicare PIN
L31000003Medicare PIN