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General NPI Number Information
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NPI Number | 1720052392
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Entity Type | Individual
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Provider Name | AMY JO CALDER OD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1142 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90247-3538
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Country | US
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Telephone | 310-323-5095
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Fax | 310-323-6046
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Provider Business Mailing Address
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Address Line | 1142 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90247-3538
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Country | US
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Telephone | 310-323-5095
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Fax | 310-323-6046
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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 | 12370T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5870563-9934
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License Number State | UT
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