MEDICARE: DR. AMANDA ANN DORI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG002219	PA

General Provider Information

NPI Number	:	1104057405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA ANN DORI O.D.

Provider Business Mailing Address
First Line	:	915 N ST SE BLDG 175
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N ST SE BLDG 175
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:	202-433-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	05/10/2010

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