Healthcare Provider Details

I. General information

NPI: 1710484001
Provider Name (Legal Business Name): EMILEE DAILEY AMACKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

101 BODIN CIRCLE
TRAVIS CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5332
  • Fax:
Mailing address:
  • Phone: 707-423-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.38443
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: