Provider Demographics
NPI:1194747352
Name:ZODIKOFF, ANDREW D (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:ZODIKOFF
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 1:49 WHITTEMORE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1364 WORCESTER ROAD
Practice Address - Street 2:NATICK EYE ASSOCIATES,PC
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1514
Practice Address - Country:US
Practice Address - Phone:508-655-8127
Practice Address - Fax:508-652-0819
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA51277OtherHARVARD PILGRIM HEALTHCAR
MA220314OtherUNITED HEALTHCARE
MA3057417OtherCIGNA HEALTHCARE
MA0005612479OtherAETNA
MAW16109OtherBLUECROSS BLUESHIELD
MAT91883Medicare UPIN
MA427158Medicare ID - Type Unspecified