Healthcare Provider Details

I. General information

NPI: 1134435225
Provider Name (Legal Business Name): ANDREA M NEEDHAM O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S SILVER ST
PAOLA KS
66071-1469
US

IV. Provider business mailing address

2 S SILVER ST
PAOLA KS
66071-1469
US

V. Phone/Fax

Practice location:
  • Phone: 913-951-7696
  • Fax:
Mailing address:
  • Phone: 913-951-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1819
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: