MEDICARE: DR. ANDREA SUSAN BASSI O.D

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	0601800390	VA

General Provider Information

NPI Number	:	1912903683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA SUSAN BASSI O.D

Provider Business Mailing Address
First Line	:	409 SCHUYLER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-2350
Country	:	US
Telephone Number	:	757-314-7414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 NIDER BLVD
Second Line	:	STE 100
City	:	NORFOLK
State	:	VA
Zip	:	23521-2701
Country	:	US
Telephone Number	:	757-314-7413
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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