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General NPI Number Information
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NPI Number | 1497502751
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Entity Type | Individual
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Provider Name | JEREMY ANDIA OD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2024
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 804 S VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91502-2427
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Country | US
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Telephone | 623-910-4209
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Fax |
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Provider Business Mailing Address
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Address Line | 749 N VENDOME ST APT 6
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City | LOS ANGELES
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State | CA
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Zip | 90026-2856
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Country | US
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Telephone | 623-910-4209
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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 | 36156
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License Number State | CA
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