Healthcare Provider Details

I. General information

NPI: 1790810505
Provider Name (Legal Business Name): AMANDA BRITT BADEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5345
US

IV. Provider business mailing address

1729 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5345
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-3601
  • Fax: 910-763-4608
Mailing address:
  • Phone: 910-763-3601
  • Fax: 910-763-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: