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General NPI Number Information
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NPI Number | 1467866509
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Entity Type | Individual
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Provider Name | ANDREW CONGDON O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 3003 CLEVELAND AVE A
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City | MARINETTE
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State | WI
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Zip | 54143-3760
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Country | US
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Telephone | 920-883-0632
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 CLEVELAND AVE A
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City | MARINETTE
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State | WI
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Zip | 54143-3760
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Country | US
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Telephone | 715-732-2101
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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 | 3346-35
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License Number State | WI
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