Provider Demographics
NPI:1700282928
Name:ANDRASKO, GARY (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:ANDRASKO
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 1:3943 TARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2299
Mailing Address - Country:US
Mailing Address - Phone:614-459-3363
Mailing Address - Fax:
Practice Address - Street 1:3943 TARRINGTON LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2299
Practice Address - Country:US
Practice Address - Phone:614-459-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-16
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist