MEDICARE: MARANDA AMORNYARD WEST 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	6438	OH

General Provider Information

NPI Number	:	1205380425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARANDA AMORNYARD WEST O.D.

Provider Business Mailing Address
First Line	:	511 W 1ST AVE APT 201
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1595 GEORGESVILLE SQUARE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3689
Country	:	US
Telephone Number	:	614-385-0088
Fax Number	:	614-853-2442

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

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	10/01/2018

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