Provider Demographics
NPI:1992060594
Name:ROSSOW, ANDREA T (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:ROSSOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:T
Other - Last Name:SEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:763-546-8422
Mailing Address - Fax:763-546-8114
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:763-546-8422
Practice Address - Fax:763-546-8114
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004708152W00000X
MN3342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist