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General NPI Number Information
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NPI Number | 1609758960
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Entity Type | Individual
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Provider Name | AMANDA ARIE
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Gender | Female
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 521 E HARTFORD AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-2004
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Country | US
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Telephone | 580-765-3379
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Fax |
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Provider Business Mailing Address
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Address Line | 2016 HUNTINGTON PL
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City | PONCA CITY
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State | OK
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Zip | 74604-1523
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Country | US
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Telephone |
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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 | 3289
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License Number State | OK
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