MEDICARE: AMY THICH, O.D., A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1417516725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY THICH, O.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1844 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2517
Country	:	US
Telephone Number	:	415-409-0888
Fax Number	:	866-864-6038

Provider Business Practice Location Address
First Line	:	1844 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2517
Country	:	US
Telephone Number	:	415-409-0888
Fax Number	:	866-864-6038

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. AMY THICH
Credential	:	OD
Telephone Number	:	415-409-0888

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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