Provider Demographics
NPI:1275233637
Name:BALL, ANDREW (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BALL
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10454 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1433
Mailing Address - Country:US
Mailing Address - Phone:208-672-1370
Mailing Address - Fax:208-672-1404
Practice Address - Street 1:10454 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1433
Practice Address - Country:US
Practice Address - Phone:208-672-1370
Practice Address - Fax:208-672-1404
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist