Healthcare Provider Details

I. General information

NPI: 1790581171
Provider Name (Legal Business Name): AMANDA ZHANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MINOR HALL
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

56 LEEWOOD LOOP
STATEN ISLAND NY
10304-3450
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2020
  • Fax:
Mailing address:
  • Phone: 920-765-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: