MEDICARE: DR. AMY BROOKE MACKEY CARENZA OD

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	2019020522	MO

General Provider Information

NPI Number	:	1174183529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY BROOKE MACKEY CARENZA OD

Provider Business Mailing Address
First Line	:	100 PIPER HILL DR STE D
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1616
Country	:	US
Telephone Number	:	256-997-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 MCKELVEY RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1531
Country	:	US
Telephone Number	:	314-434-9450
Fax Number	:

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	12/03/2019

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