Provider Demographics
NPI:1932892536
Name:LONGWELL, ANDREW (OD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:LONGWELL
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 1:3800 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:GREECE
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2529
Mailing Address - Country:US
Mailing Address - Phone:585-957-7386
Mailing Address - Fax:
Practice Address - Street 1:3800 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:GREECE
Practice Address - State:NY
Practice Address - Zip Code:14616-2529
Practice Address - Country:US
Practice Address - Phone:585-957-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009659156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician