MEDICARE: AMANDA ISABELLE ANTONETTI NYS LICENSED OPTICIA

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	156FX1800X	Optician	010345	NY

General Provider Information

NPI Number	:	1518813997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ISABELLE ANTONETTI NYS LICENSED OPTICIA

Provider Business Mailing Address
First Line	:	50 EASTVIEW MALL DR
Second Line	:
City	:	VICTOR
State	:	NY
Zip	:	14564-1003
Country	:	US
Telephone Number	:	585-223-0430
Fax Number	:	585-223-5024

Provider Business Practice Location Address
First Line	:	50 EASTVIEW MALL DR
Second Line	:
City	:	VICTOR
State	:	NY
Zip	:	14564-1003
Country	:	US
Telephone Number	:	585-223-0430
Fax Number	:	585-223-5024

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

Provider Enumeration Date	:	03/07/2026
Last Update Date	:	03/07/2026

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