Provider Demographics
NPI:1992954531
Name:BUCHBAUM, ANDREA DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DAWN
Last Name:BUCHBAUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:DAWN
Other - Last Name:BEEDLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10120 W. 119TH STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1600
Mailing Address - Country:US
Mailing Address - Phone:913-339-9090
Mailing Address - Fax:913-339-6417
Practice Address - Street 1:10120 W. 119TH STREET
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1600
Practice Address - Country:US
Practice Address - Phone:913-339-9090
Practice Address - Fax:913-339-6417
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1802152W00000X
MO2008019684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist