Provider Demographics
NPI:1740365428
Name:CAPPS, ANDREA DERI (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DERI
Last Name:CAPPS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BOBBY JONES EXPY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5255
Mailing Address - Country:US
Mailing Address - Phone:706-860-1171
Mailing Address - Fax:706-860-1841
Practice Address - Street 1:217 BOBBY JONES EXPY
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5255
Practice Address - Country:US
Practice Address - Phone:706-860-1171
Practice Address - Fax:706-860-1841
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
79712Medicare UPIN
41ZCDQZMedicare ID - Type Unspecified