Healthcare Provider Details

I. General information

NPI: 1356348437
Provider Name (Legal Business Name): ALEXANDAR ANDRICH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10139 ROYALTON RD SUITE D
NORTH ROYALTON OH
44133-4472
US

IV. Provider business mailing address

10139 ROYALTON RD STE D
NORTH ROYALTON OH
44133-4473
US

V. Phone/Fax

Practice location:
  • Phone: 440-230-0923
  • Fax: 440-786-5086
Mailing address:
  • Phone: 330-915-3007
  • Fax: 330-319-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4693/T1471
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number4693/T1471
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4693/T1471
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4693/T1471
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: