Healthcare Provider Details

I. General information

NPI: 1841743234
Provider Name (Legal Business Name): AMANDA LUCETTE YOUNGER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 MID RIVERS MALL DR
COTTLEVILLE MO
63376-2883
US

IV. Provider business mailing address

9979 WINGHAVEN BLVD STE 210
O FALLON MO
63368-3628
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-5378
  • Fax: 636-244-5378
Mailing address:
  • Phone: 636-695-8555
  • Fax: 636-695-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2748
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2017009254
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: