Healthcare Provider Details

I. General information

NPI: 1548192412
Provider Name (Legal Business Name): AMANDA AMSDELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9695 S YOSEMITE ST
LONE TREE CO
80124-2888
US

IV. Provider business mailing address

9695 S YOSEMITE ST
LONE TREE CO
80124-2888
US

V. Phone/Fax

Practice location:
  • Phone: 440-813-8190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004203
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: