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General NPI Number Information
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NPI Number | 1578453320
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Entity Type | Individual
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Provider Name | ANDREW SCOTT MAXWELL OD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 149 HAZARD AVE # 4521
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City | ENFIELD
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State | CT
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Zip | 06082-4521
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Country | US
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Telephone | 860-749-0757
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Fax | 860-763-4335
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Provider Business Mailing Address
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Address Line | 8 WILSON CT
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City | ENFIELD
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State | CT
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Zip | 06082-5225
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Country | US
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Telephone | 860-805-2248
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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 | 3405
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License Number State | CT
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