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General NPI Number Information
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NPI Number | 1841743234
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Entity Type | Individual
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Provider Name | AMANDA LUCETTE YOUNGER O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 4702 MID RIVERS MALL DR
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City | COTTLEVILLE
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State | MO
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Zip | 63376-2883
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Country | US
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Telephone | 636-244-5378
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Fax | 636-244-5378
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Provider Business Mailing Address
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Address Line | 9979 WINGHAVEN BLVD STE 210
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City | O FALLON
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State | MO
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Zip | 63368-3628
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Country | US
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Telephone | 636-695-8555
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Fax | 636-695-8555
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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 | 2748
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License Number State | AR
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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 | 2017009254
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License Number State | MO
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