Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 490100462 | MI |
N | 152WV0400X | Optomitrist - Vision Therapist | 4901004652 | MI |
NPI | 1548558935 |
---|---|
Provider Name | Dr. Amanda M Hodge |
First Address | Allegan, MI 49010-1301 |
Second Address | Allegan, MI 49010-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 22/12/2011 |