Healthcare Provider Details

I. General information

NPI: 1407471758
Provider Name (Legal Business Name): AMANDA DAWN MORRIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CEDAR CREEK GRADE STE 100
WINCHESTER VA
22601-7100
US

IV. Provider business mailing address

905 CEDAR CREEK GRADE STE 100
WINCHESTER VA
22601-7100
US

V. Phone/Fax

Practice location:
  • Phone: 540-665-0541
  • Fax: 540-665-8286
Mailing address:
  • Phone: 540-665-0541
  • Fax: 540-665-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: