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General NPI Number Information
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NPI Number | 1073586012
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Entity Type | Individual
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Provider Name | CASEY J ANDRUS O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 201 INDEPENDENCE SUITE 101
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City | COLUMBUS
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State | MS
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Zip | 39710-5300
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Country | US
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Telephone | 662-434-2188
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Fax | 662-434-2181
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Provider Business Mailing Address
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Address Line | 7390B SALEM DR
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City | COLUMBUS
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State | MS
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Zip | 39705-7622
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Country | US
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Telephone | 662-434-5076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100031
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License Number State | ID
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