Healthcare Provider Details

I. General information

NPI: 1013649623
Provider Name (Legal Business Name): ANDREW PRICE OD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 CANYON SPRINGS PKWY
RIVERSIDE CA
92507-0932
US

IV. Provider business mailing address

PO BOX 33542
RIVERSIDE CA
92519-0542
US

V. Phone/Fax

Practice location:
  • Phone: 951-988-2020
  • Fax: 951-382-6226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number35140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number35140
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number35140
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number35140
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number35140
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number35140
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: