MEDICARE: DR. AMANDA AMSDELL 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	OPT.0004203	CO

General Provider Information

NPI Number	:	1548192412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA AMSDELL OD

Provider Business Mailing Address
First Line	:	9695 S YOSEMITE ST
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9695 S YOSEMITE ST
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	440-813-8190
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/05/2026

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