Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | ODP-100246 | ID |
NPI | 1194823930 |
---|---|
Provider Name | Dr. Deborah Ann Amato |
First Address | Boise, ID 83704-1250 |
Second Address | Boise, ID 83709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U19272 | (02) | OR |