Provider Demographics
NPI:1730147059
Name:SILVERS, ANDREA CAROL (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROL
Last Name:SILVERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16255 VENTURA BLVD
Mailing Address - Street 2:STE 705
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2302
Mailing Address - Country:US
Mailing Address - Phone:818-986-8860
Mailing Address - Fax:818-986-7324
Practice Address - Street 1:16255 VENTURA BLVD
Practice Address - Street 2:STE 705
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2302
Practice Address - Country:US
Practice Address - Phone:818-986-8860
Practice Address - Fax:818-986-7324
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5205T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48587YMedicaid
WY1488Medicare ID - Type Unspecified
U25251Medicare UPIN