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General NPI Number Information
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NPI Number | 1194815811
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Entity Type | Individual
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Provider Name | ANDRE BARON O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 88 HIGHLAND XING
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-6052
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Country | US
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Telephone | 706-635-1194
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Fax | 706-635-1196
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Provider Business Mailing Address
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Address Line | 88 HIGHLAND XING
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-6052
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Country | US
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Telephone | 706-635-1194
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Fax | 706-635-1196
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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 | OPC3570
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002250
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License Number State | GA
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