Provider Demographics
NPI:1740869197
Name:SPRENKEL, ANDREW KENNETH (OD, FAAO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KENNETH
Last Name:SPRENKEL
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 LA LOMA PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1732
Mailing Address - Country:US
Mailing Address - Phone:530-363-4222
Mailing Address - Fax:
Practice Address - Street 1:11552 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3110
Practice Address - Country:US
Practice Address - Phone:562-868-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist