MEDICARE: IAN MCANDREW

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	OEG003495	PA

General Provider Information

NPI Number	:	1699245894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN MCANDREW

Provider Business Mailing Address
First Line	:	690 W DEKALB PIKE
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-2943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 W DEKALB PIKE
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-2943
Country	:	US
Telephone Number	:	610-337-4114
Fax Number	:

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

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	11/29/2018

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Directions to “ IAN MCANDREW ” Practice Location

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