Healthcare Provider Details

I. General information

NPI: 1033195326
Provider Name (Legal Business Name): ANDREW LEON PRITCHARD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JAMESTOWN ST SUITE 207
PHILADELPHIA PA
19128-1751
US

IV. Provider business mailing address

525 JAMESTOWN ST SUITE 207
PHILADELPHIA PA
19128-1751
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-8444
  • Fax: 215-482-8456
Mailing address:
  • Phone: 215-483-8444
  • Fax: 215-482-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: