Provider Demographics
NPI:1538179270
Name:LUSK, ANDREA L (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:LUSK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2560 GULF TO BAY BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-4421
Mailing Address - Country:US
Mailing Address - Phone:727-799-3772
Mailing Address - Fax:727-799-3772
Practice Address - Street 1:11031 US HIGHWAY 19
Practice Address - Street 2:SUITE 106
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-2213
Practice Address - Country:US
Practice Address - Phone:727-868-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85673207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51534Medicare ID - Type Unspecified
FLH10283Medicare UPIN