Individual
MR. ANDREW WADE HOWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2561 JACKSBORO PIKE, JACKSBORO, TN 37757-4847
(423) 562-1531
(423) 562-1724
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1769
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3945636
—
TN
01
—
4047683
BLUE CROSS BLUE SHIELD
TN
Enumeration date
08/01/2005
Last updated
09/21/2021
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