Provider Demographics
NPI:1982712618
Name:DODD, ANDREW M (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:DODD
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 1:2282 NEWTON STREET
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305
Mailing Address - Country:US
Mailing Address - Phone:330-794-9700
Mailing Address - Fax:330-794-6791
Practice Address - Street 1:2282 NEWTON STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305
Practice Address - Country:US
Practice Address - Phone:330-794-9700
Practice Address - Fax:330-794-6791
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5302 T2211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418780Medicaid
V07188Medicare UPIN