MEDICARE: ANDREW BALL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODP-100594	ID

General Provider Information

NPI Number	:	1275233637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW BALL OD

Provider Business Mailing Address
First Line	:	10454 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-672-1370
Fax Number	:	208-672-1404

Provider Business Practice Location Address
First Line	:	10454 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-672-1370
Fax Number	:	208-672-1404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	04/29/2025

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Directions to “ ANDREW BALL OD” Practice Location

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