MEDICARE: DR. ALEXANDAR ANDRICH 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	152WP0200X	Pediatric Optometrist	4693/T1471	OH
2	152WS0006X	Sports Vision Optometrist	4693/T1471	OH
3	152WV0400X	Vision Therapy Optometrist	4693/T1471	OH
4	152WL0500X	Low Vision Rehabilitation Optometrist	4693/T1471	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356348437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDAR ANDRICH O.D.

Provider Business Mailing Address
First Line	:	10139 ROYALTON RD
Second Line	:	STE D
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-4473
Country	:	US
Telephone Number	:	330-915-3007
Fax Number	:	330-319-6390

Provider Business Practice Location Address
First Line	:	10139 ROYALTON RD
Second Line	:	SUITE D
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-4472
Country	:	US
Telephone Number	:	440-230-0923
Fax Number	:	440-786-5086

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	03/22/2022

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