Healthcare Provider Details

I. General information

NPI: 1730963190
Provider Name (Legal Business Name): MELODY SERRINA AMADOR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E BAILEY BOSWELL RD
FORT WORTH TX
76131-3575
US

IV. Provider business mailing address

616 E BAILEY BOSWELL RD
FORT WORTH TX
76131-3575
US

V. Phone/Fax

Practice location:
  • Phone: 682-382-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10914T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: