Healthcare Provider Details

I. General information

NPI: 1720068281
Provider Name (Legal Business Name): ANDREW T ENGLE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 70TH STREET GULF
MARATHON FL
33050-4801
US

IV. Provider business mailing address

554 70TH STREET GULF
MARATHON FL
33050-4801
US

V. Phone/Fax

Practice location:
  • Phone: 240-784-6144
  • Fax:
Mailing address:
  • Phone: 240-784-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2232/OC1857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: