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General NPI Number Information
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NPI Number | 1215317474
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Entity Type | Individual
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Provider Name | AMANDA ALVES KHAMIS O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 1601 E CHAPMAN AVE
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City | FULLERTON
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State | CA
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Zip | 92831-4015
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Country | US
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Telephone | 145-265-5515
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Fax | 714-526-5384
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Provider Business Mailing Address
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Address Line | 1601 E CHAPMAN AVE
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City | FULLERTON
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State | CA
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Zip | 92831-4015
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Country | US
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Telephone | 145-265-5515
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 15219
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 15219
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 15219
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License Number State | CA
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