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General NPI Number Information
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NPI Number | 1386974566
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Entity Type | Organization
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Legal Business Name | CASEY J. ANDRUS, O.D., PLLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 1203 E DIVISION ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4101
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Country | US
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Telephone | 360-336-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 71ST DR NE
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City | MARYSVILLE
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State | WA
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Zip | 98270-8951
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CASEY J, ANDRUS
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Credential | O.D.
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Telephone | 360-657-2670
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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 | 4046
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License Number State | WA
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