Healthcare Provider Details

I. General information

NPI: 1063370989
Provider Name (Legal Business Name): AMANDA CHIKA CHIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 BEAL PKWY N UNIT 102
FORT WALTON BEACH FL
32547-3063
US

IV. Provider business mailing address

160 S MATTIE M KELLY BLVD APT 3203
DESTIN FL
32541-3261
US

V. Phone/Fax

Practice location:
  • Phone: 850-586-7888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC7021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: