Healthcare Provider Details

I. General information

NPI: 1235589862
Provider Name (Legal Business Name): AMANDA HAKE ZGHALL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE HAKE OD

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHARLOTTE ST
KANSAS CITY MO
64108-2727
US

IV. Provider business mailing address

2101 CHARLOTTE ST
KANSAS CITY MO
64108-2727
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-3900
  • Fax:
Mailing address:
  • Phone: 816-404-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2017022221
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: