Provider Demographics
NPI:1174143507
Name:HIMMEL, AMANDA MARIE (OD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HIMMEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 JESSICA CIR
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-8593
Mailing Address - Country:US
Mailing Address - Phone:989-415-5105
Mailing Address - Fax:
Practice Address - Street 1:907 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8147
Practice Address - Country:US
Practice Address - Phone:734-878-7444
Practice Address - Fax:734-878-0678
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist