Provider Demographics
NPI:1720067978
Name:ANDRE, PAUL ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:ANDRE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:762 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-5202
Mailing Address - Country:US
Mailing Address - Phone:998-559-2649
Mailing Address - Fax:847-688-2289
Practice Address - Street 1:930 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93246-4600
Practice Address - Country:US
Practice Address - Phone:998-559-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10237T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist