Healthcare Provider Details

I. General information

NPI: 1700792082
Provider Name (Legal Business Name): ANDREW KENNETH DELK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

764 36TH ST
MANHATTAN BEACH CA
90266-3434
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 310-595-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberORT011432-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: