Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1926DT | KY |
NPI | 1013349869 |
---|---|
Provider Name | Dr. Amanda Joy Korth |
First Address | Bondurant, IA 50035-1451 |
Second Address | West Union, IA 52175-1347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2013 |
Last Update Date | 06/04/2020 |