Provider Demographics
NPI:1578453320
Name:MAXWELL, ANDREW SCOTT (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:MAXWELL
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 1:8 WILSON CT
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5225
Mailing Address - Country:US
Mailing Address - Phone:860-805-2248
Mailing Address - Fax:
Practice Address - Street 1:149 HAZARD AVE # 4521
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4521
Practice Address - Country:US
Practice Address - Phone:860-749-0757
Practice Address - Fax:860-763-4335
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist