Provider Demographics
NPI:1316974025
Name:HUSTAVA, ANDREW J (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:HUSTAVA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2321 CROSS TIMBERS RD
Mailing Address - Street 2:STE 425
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2618
Mailing Address - Country:US
Mailing Address - Phone:972-724-3030
Mailing Address - Fax:972-691-3721
Practice Address - Street 1:2321 CROSS TIMBERS RD
Practice Address - Street 2:STE 425
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2618
Practice Address - Country:US
Practice Address - Phone:972-724-3030
Practice Address - Fax:972-691-3721
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5408TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU82045Medicare UPIN