MEDICARE: DR. ANDREA L EARLEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4923	OH

General Provider Information

NPI Number	:	1013968353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA L EARLEY O.D.

Provider Business Mailing Address
First Line	:	15933 CLAYTON RD STE 210
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2172
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:

Provider Business Practice Location Address
First Line	:	8051 VESTA AVE
Second Line	:
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2080
Country	:	US
Telephone Number	:	330-468-0585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/27/2026

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