Healthcare Provider Details

I. General information

NPI: 1518647379
Provider Name (Legal Business Name): JAMES ANDREWS IV OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MAIN ST
MONSON MA
01057-1371
US

IV. Provider business mailing address

170 MAIN ST
MONSON MA
01057-1371
US

V. Phone/Fax

Practice location:
  • Phone: 413-267-4200
  • Fax: 413-893-9661
Mailing address:
  • Phone: 413-267-4200
  • Fax: 413-893-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: