Provider Demographics
NPI:1740279116
Name:ADAMICH, ANDREW R (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:ADAMICH
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 1:2233 E. MAIN STREET
Mailing Address - Street 2:BUSINESS OPTIONS MEDICAL BILLING
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:49 MILL STREET
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:970-884-2020
Practice Address - Fax:970-884-2977
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2330152W00000X
COOPT.0002330152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77857852Medicaid
CO77857852Medicaid
COCO304738Medicare PIN