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General NPI Number Information
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NPI Number | 1982334025
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Entity Type | Individual
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Provider Name | MADELINE MARIE GIANANDREA OD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 10709 S WALTON RD
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City | LA GRANDE
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State | OR
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Zip | 97850-8490
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Country | US
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Telephone | 541-962-7753
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Fax |
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Provider Business Mailing Address
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Address Line | 67038 HUNTER RD
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City | SUMMERVILLE
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State | OR
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Zip | 97876-8129
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Country | US
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Telephone | 541-910-7091
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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 | 4635ATI
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License Number State | OR
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