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General NPI Number Information
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NPI Number | 1740840008
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Entity Type | Individual
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Provider Name | AMANDA KATHLEEN HARGROVE OD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 2430 S I 35 E STE 156
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City | DENTON
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State | TX
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Zip | 76205-4989
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Country | US
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Telephone | 940-484-5587
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 BLATTNER DR
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-6380
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Country | US
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Telephone | 573-579-4809
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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 | 2019021297
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License Number State | MO
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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 | 9842TG
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License Number State | TX
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