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General NPI Number Information
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NPI Number | 1104911098
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Entity Type | Organization
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Legal Business Name | ANDREANOS JORDANOPOULOS OD INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 1573 SOUTH WICKHAM ROAD
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3540
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Country | US
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Telephone | 321-723-8115
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Fax | 321-723-7388
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Provider Business Mailing Address
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Address Line | 1573 SOUTH WICKHAM ROAD
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3540
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Country | US
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Telephone | 321-723-8115
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Fax | 321-723-7388
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Authorized Official
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Title or Position | PRESIDENT OWNER OPTOMETRIST
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Name | ANDREANOS JORDANOPOULOS
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Credential | OD
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Telephone | 321-723-8115
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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 | FL2531
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License Number State | FL
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