Provider Demographics
NPI:1225037393
Name:FELTZ, ANDREW D (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:FELTZ
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 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2420
Mailing Address - Fax:502-244-2441
Practice Address - Street 1:740 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5277
Practice Address - Country:US
Practice Address - Phone:419-874-0393
Practice Address - Fax:419-874-0394
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003492A152W00000X
PAOEG002019152W00000X
MIL1374544152W00000X
OH4642 T1417152W00000X
NYTUV007663-1152W00000X
NJ27OA00629300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00358217OtherRAILROAD MEDICARE
OHP00108045OtherRAILROAD MEDICARE
OH000000358717OtherANTHEM
OH410048817OtherRAILROAD MEDICARE
OH9363143OtherPHCS/LUMENOS
OH5057556OtherAETNA
SCD19228Medicaid
OH000000223970OtherANTHEM
OH084185OtherHARVARD PILGRIM
OH9363143OtherPHCS/NIPPON
PA102372670 0001Medicaid
OH2272795Medicaid
OHP00108045OtherRAILROAD MEDICARE
OH084185OtherHARVARD PILGRIM
OHP00358217OtherRAILROAD MEDICARE
PA102372670 0001Medicaid
SCSC7893F642Medicare PIN
OH$$$$$$$$$003OtherMEDICAL MUTUAL
OHP00358217OtherRAILROAD MEDICARE
OH084185OtherHARVARD PILGRIM
OH084185Medicare PIN
OH5057556OtherAETNA