Provider Demographics
NPI:1528135803
Name:HORN, ANDREW P (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:HORN
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 1:213 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5514
Mailing Address - Country:US
Mailing Address - Phone:516-256-2020
Mailing Address - Fax:
Practice Address - Street 1:213 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5514
Practice Address - Country:US
Practice Address - Phone:516-256-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-005300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU32672Medicare UPIN
NYC47872Medicare ID - Type UnspecifiedMEDICARE