Provider Demographics
NPI:1871563270
Name:ANDREN, JOHN F (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ANDREN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 JONESTOWN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4021
Mailing Address - Country:US
Mailing Address - Phone:717-652-5410
Mailing Address - Fax:717-652-7656
Practice Address - Street 1:5405 JONESTOWN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4021
Practice Address - Country:US
Practice Address - Phone:717-652-5410
Practice Address - Fax:717-652-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0305060001Medicare NSC
PA181834Medicare PIN
PAT29974Medicare UPIN