Healthcare Provider Details

I. General information

NPI: 1912236761
Provider Name (Legal Business Name): AMANDA BRANDNER SMITH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BRANDNER OD

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28322 LEWES GEORGETOWN HWY
MILTON DE
19968-3117
US

IV. Provider business mailing address

PO BOX 58
NASSAU DE
19969-0058
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-2020
  • Fax: 302-684-2021
Mailing address:
  • Phone: 703-847-8899
  • Fax: 703-991-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number13-0001341
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI3-0001341
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: