Provider Demographics
NPI:1174534051
Name:STROM, AMANDA RACHELLE (OD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHELLE
Last Name:STROM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RACHELLE
Other - Last Name:WINDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7200 W 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2624
Mailing Address - Country:US
Mailing Address - Phone:913-897-9299
Mailing Address - Fax:913-897-3031
Practice Address - Street 1:7200 W 129TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2624
Practice Address - Country:US
Practice Address - Phone:913-897-9299
Practice Address - Fax:913-897-3031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034233152W00000X
KS1724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651076OtherBCBSKS
KS200347910AMedicaid
MO36255017OtherBCBSKC
MO36255017OtherBCBSKC
1163780001Medicare NSC