Provider Demographics
NPI:1720068281
Name:ENGLE, ANDREW T (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:ENGLE
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 1:554 70TH STREET GULF
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-4801
Mailing Address - Country:US
Mailing Address - Phone:240-784-6144
Mailing Address - Fax:
Practice Address - Street 1:554 70TH STREET GULF
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-4801
Practice Address - Country:US
Practice Address - Phone:240-784-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2232/OC1857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist