MEDICARE: DR. AMY JO CALDER 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	12370T	CA
2	152W00000X	Optometrist	5870563-9934	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720052392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY JO CALDER OD

Provider Business Mailing Address
First Line	:	1142 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3538
Country	:	US
Telephone Number	:	310-323-5095
Fax Number	:	310-323-6046

Provider Business Practice Location Address
First Line	:	1142 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3538
Country	:	US
Telephone Number	:	310-323-5095
Fax Number	:	310-323-6046

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	05/21/2008

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