MEDICARE: ANDREA J. WASHINGTON O.D. PC

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	152WV0400X	Vision Therapy Optometrist
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1316129463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREA J. WASHINGTON O.D. PC

Provider Business Mailing Address
First Line	:	PO BOX 1506
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30015-1506
Country	:	US
Telephone Number	:	678-682-5524
Fax Number	:	866-924-3530

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	:	OWNER/OPTOMETRIST
Name	:	DR. ANDREA J WASHINGTON
Credential	:	O.D.
Telephone Number	:	678-682-5524

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	10/11/2019

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