Provider Demographics
NPI:1720107469
Name:ANDREWS, JENNIFER DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DIANE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3024 23RD AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2923
Mailing Address - Country:US
Mailing Address - Phone:206-235-0789
Mailing Address - Fax:206-623-5461
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 634
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-344-2020
Practice Address - Fax:206-623-5461
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV65971Medicare UPIN