Healthcare Provider Details

I. General information

NPI: 1730927062
Provider Name (Legal Business Name): AMANDA P HORDOS OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SUNNYSIDE BLVD
PLAINVIEW NY
11803-1504
US

IV. Provider business mailing address

11 MAHAN RD
OLD BETHPAGE NY
11804-1213
US

V. Phone/Fax

Practice location:
  • Phone: 631-877-0651
  • Fax:
Mailing address:
  • Phone: 631-877-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. AMANDA P HORDOS
Title or Position: OWNER
Credential: OD
Phone: 631-877-0651