Healthcare Provider Details

I. General information

NPI: 1972430247
Provider Name (Legal Business Name): AMELIA LEE TAYLOR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 OLD COURTHOUSE RD
APPOMATTOX VA
24522-9853
US

IV. Provider business mailing address

5213 MEADOW POINTE DR
SOUTHAVEN MS
38672-6743
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12345678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: