MEDICARE: ANDREW R SCHWICHTENBERG 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	ODT1154	TN

General Provider Information

NPI Number	:	1902901713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW R SCHWICHTENBERG O.D.

Provider Business Mailing Address
First Line	:	2829 E OAKLAND AVE
Second Line	:	SUITE 1
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1347
Country	:	US
Telephone Number	:	423-283-4590
Fax Number	:	423-283-0867

Provider Business Practice Location Address
First Line	:	2829 E OAKLAND AVE
Second Line	:	SUITE 1
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1347
Country	:	US
Telephone Number	:	423-283-4590
Fax Number	:	423-283-0867

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/12/2018

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