Provider Demographics
NPI:1316129463
Name:ANDREA J. WASHINGTON O.D. PC
Entity type:Organization
Organization Name:ANDREA J. WASHINGTON O.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-682-5524
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-1506
Mailing Address - Country:US
Mailing Address - Phone:678-682-5524
Mailing Address - Fax:866-924-3530
Practice Address - Street 1:4106 MILL ST NE STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2539
Practice Address - Country:US
Practice Address - Phone:678-625-3937
Practice Address - Fax:770-786-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty