Healthcare Provider Details

I. General information

NPI: 1922239631
Provider Name (Legal Business Name): AMANDA JIMENEZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOVEY RD
PENSACOLA FL
32508-1044
US

IV. Provider business mailing address

220 HOVEY RD
PENSACOLA FL
32508-1044
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-4554
  • Fax:
Mailing address:
  • Phone: 850-452-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002232
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberPAOEG002232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: