Basic Information
| Provider Information | |||||||||
| NPI: | 1902036254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 752 N HIGH POINT RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537172236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088244000 | ||||||||
| FaxNumber: | 6088244932 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971322912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038479183 | ||||||||
| FaxNumber: | 9718328578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3305ATI | OR | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 3217-35 | WI | N | Eye and Vision Services Providers | Optometrist |
No ID Information.