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General NPI Number Information
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NPI Number | 1780989467
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Entity Type | Organization
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Legal Business Name | AMY H FORESTE PLLC
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 3400 GATEWAY BLVD
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City | PRESCOTT
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State | AZ
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Zip | 86303-6848
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Country | US
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Telephone | 928-778-4402
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Fax | 928-778-4402
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Provider Business Mailing Address
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Address Line | 2053 PLATEAU
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City | PRESCOTT
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State | AZ
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Zip | 86305-2169
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Country | US
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Telephone | 928-541-0615
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. AMY H CHAMP
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Credential | O.D.
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Telephone | 928-541-0615
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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 | 967
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License Number State | AZ
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