MEDICARE: ANDREW HUMISTON OD

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	2901	NC

General Provider Information

NPI Number	:	1790485100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW HUMISTON OD

Provider Business Mailing Address
First Line	:	225 E LEE AVE
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-8227
Country	:	US
Telephone Number	:	336-679-2931
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 E LEE AVE
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-8227
Country	:	US
Telephone Number	:	336-679-2931
Fax Number	:

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

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	04/17/2026

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