Healthcare Provider Details

I. General information

NPI: 1164417549
Provider Name (Legal Business Name): ANDREW JOSEPH LOVSIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ACADEMY ST
RANDLEMAN NC
27317-1504
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 336-495-3937
  • Fax: 336-495-3938
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1868
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: