Provider Demographics
NPI:1982757571
Name:MA, ANDREW S (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:MA
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 1:15119 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5044
Mailing Address - Country:US
Mailing Address - Phone:415-710-3792
Mailing Address - Fax:
Practice Address - Street 1:10969 N WOLFE RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0617
Practice Address - Country:US
Practice Address - Phone:415-710-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist