MEDICARE: DR. ANDREA WASHINGTON 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	6630TG	TX
2	152W00000X	Optometrist	1420-541T	LA
3	152W00000X	Optometrist	2341	GA

General Provider Information

NPI Number	:	1205830577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA WASHINGTON O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1506
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30015-1506
Country	:	US
Telephone Number	:	678-625-3937
Fax Number	:	770-786-8216

Provider Business Practice Location Address
First Line	:	4106 MILL ST NE STE A
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2539
Country	:	US
Telephone Number	:	678-625-3937
Fax Number	:	770-786-8216

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	02/20/2018

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