Healthcare Provider Details

I. General information

NPI: 1942126693
Provider Name (Legal Business Name): AMANDA FALLS KOFFMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 S MILITARY TRL STE 690
DELRAY BEACH FL
33484-6533
US

IV. Provider business mailing address

16244 S MILITARY TRL STE 690
DELRAY BEACH FL
33484-6533
US

V. Phone/Fax

Practice location:
  • Phone: 561-925-8080
  • Fax:
Mailing address:
  • Phone: 561-925-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: