Healthcare Provider Details

I. General information

NPI: 1740272582
Provider Name (Legal Business Name): PAULA M ANDROS-ANDRZEJEWSKA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18891 PEARL RD
STRONGSVILLE OH
44136-6930
US

IV. Provider business mailing address

18891 PEARL RD
STRONGSVILLE OH
44136-6930
US

V. Phone/Fax

Practice location:
  • Phone: 440-268-0808
  • Fax: 440-268-0208
Mailing address:
  • Phone: 440-268-0808
  • Fax: 440-268-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4819
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT1684
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4819
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number4819
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4819
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: