Healthcare Provider Details

I. General information

NPI: 1982757571
Provider Name (Legal Business Name): ANDREW S MA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43621 PACIFIC COMMONS BLVD
FREMONT CA
94538-3809
US

IV. Provider business mailing address

43621 PACIFIC COMMONS BLVD
FREMONT CA
94538-3809
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-0400
  • Fax:
Mailing address:
  • Phone: 415-710-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: