MEDICARE: MADELINE MARIE GIANANDREA 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	4635ATI	OR

General Provider Information

NPI Number	:	1982334025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE MARIE GIANANDREA OD

Provider Business Mailing Address
First Line	:	67038 HUNTER RD
Second Line	:
City	:	SUMMERVILLE
State	:	OR
Zip	:	97876-8129
Country	:	US
Telephone Number	:	541-910-7091
Fax Number	:

Provider Business Practice Location Address
First Line	:	10709 S WALTON RD
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-8490
Country	:	US
Telephone Number	:	541-962-7753
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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