Provider Demographics
NPI:1700083169
Name:JOSEPHS, ANDREW M (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:JOSEPHS
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 1:250 N 18TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1482
Mailing Address - Country:US
Mailing Address - Phone:608-325-7200
Mailing Address - Fax:
Practice Address - Street 1:250 N 18TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1482
Practice Address - Country:US
Practice Address - Phone:920-216-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3082-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38631700Medicaid
000569015Medicare PIN
000526020Medicare PIN
P00426001Medicare PIN
000571490Medicare PIN