Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT 7925 TPA | CA |
NPI | 1003021205 |
---|---|
Provider Name | Dr. Dean Kenton Amundsen |
First Address | Camarillo, CA 93010-2398 |
Second Address | Camarillo, CA 93010-2398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |