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General NPI Number Information
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NPI Number | 1174183529
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Entity Type | Individual
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Provider Name | AMY BROOKE MACKEY CARENZA OD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 2311 MCKELVEY RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-1531
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Country | US
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Telephone | 314-434-9450
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PIPER HILL DR STE D
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City | SAINT PETERS
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State | MO
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Zip | 63376-1616
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Country | US
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Telephone | 256-997-7058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2019020522
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License Number State | MO
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