Healthcare Provider Details

I. General information

NPI: 1013968353
Provider Name (Legal Business Name): ANDREA L EARLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 VESTA AVE
NORTHFIELD OH
44067-2080
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-0585
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4923
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: