Provider Demographics
NPI:1912054172
Name:PRICE, ANDREA W (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:W
Last Name:PRICE
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 1:1747 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2246
Mailing Address - Country:US
Mailing Address - Phone:615-896-7477
Mailing Address - Fax:615-896-2147
Practice Address - Street 1:1747 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2246
Practice Address - Country:US
Practice Address - Phone:615-896-7477
Practice Address - Fax:615-896-2147
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNOD1823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU70024Medicare UPIN