Provider Demographics
NPI:1184767477
Name:ANDRON, ADAM ROSS (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROSS
Last Name:ANDRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:40 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2238
Mailing Address - Country:US
Mailing Address - Phone:516-433-4327
Mailing Address - Fax:201-845-8408
Practice Address - Street 1:ROUTE 4 AND 17 EYE TO EYE VISION CENTER
Practice Address - Street 2:GARDEN STATE PLAZA
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-845-8408
Practice Address - Fax:201-845-8685
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00593400152W00000X
NYTUV005689152W00000X
PAOE-007865-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059901Medicaid
NJVO4723Medicare UPIN
NJ0059901Medicaid