1225037393 NPI number — ANDREW D. FELTZ O.D.

Table of content: EMILIE ROBINSON (NPI 1194695734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225037393 NPI number — ANDREW D. FELTZ O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELTZ
Provider First Name:
ANDREW
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225037393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12910 SHELBYVILLE RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-244-2420
Provider Business Mailing Address Fax Number:
502-244-2441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 COMMERCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-5277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-874-0393
Provider Business Practice Location Address Fax Number:
419-874-0394
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18003492A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OEG002019 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: L1374544 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 4642 T1417 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: TUV007663-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 27OA00629300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00358217 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00108045 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000358717 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 410048817 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9363143 . This is a "PHCS/LUMENOS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5057556 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: D19228 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000223970 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 084185 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9363143 . This is a "PHCS/NIPPON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 102372670 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2272795 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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