Provider Demographics
NPI:1750343158
Name:LANIER, ANDREA B (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:B
Last Name:LANIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1360 E HERNDON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51172207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078924Medicaid
CAGR0078920Medicaid
CAGR0078922Medicaid
CAGR0078923Medicaid
CACGP077165Medicaid
CA00G511720Medicaid
CAGR0078921Medicaid
CAGR0078924Medicaid
CAGR0078923Medicaid
CAZZZ13882ZMedicare PIN
CAZZZ13845ZMedicare PIN
CAGR0078922Medicaid
CA00G511721Medicare PIN
CAZZZ13883ZMedicare PIN
CA00G551725Medicare PIN
CA00G511722Medicare PIN
CA00G511720Medicaid
CAA51919Medicare UPIN