Healthcare Provider Details

I. General information

NPI: 1699036764
Provider Name (Legal Business Name): AMY PELZNER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E BIDWELL ST STE 10
FOLSOM CA
95630-3315
US

IV. Provider business mailing address

626 BUCHANAN WAY
FOLSOM CA
95630-6919
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-6211
  • Fax:
Mailing address:
  • Phone: 916-204-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCA11880T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: