Healthcare Provider Details

I. General information

NPI: 1316129463
Provider Name (Legal Business Name): ANDREA J. WASHINGTON O.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 MILL ST NE STE A
COVINGTON GA
30014-2539
US

IV. Provider business mailing address

PO BOX 1506
COVINGTON GA
30015-1506
US

V. Phone/Fax

Practice location:
  • Phone: 678-625-3937
  • Fax: 770-786-8216
Mailing address:
  • Phone: 678-682-5524
  • Fax: 866-924-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA J WASHINGTON
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 678-682-5524