MEDICARE: AMANDA IDELL 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	2025023903	MO

General Provider Information

NPI Number	:	1316834492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA IDELL OD

Provider Business Mailing Address
First Line	:	1014 SE 3RD TER
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-3236
Country	:	US
Telephone Number	:	913-593-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 NE CORONADO DR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2956
Country	:	US
Telephone Number	:	816-427-9890
Fax Number	:

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

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/20/2025

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Directions to “ AMANDA IDELL OD” Practice Location

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