Provider Demographics
NPI:1366272510
Name:AMENTA, OWEN MICHAEL
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:MICHAEL
Last Name:AMENTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 NW MARKET ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4002
Mailing Address - Country:US
Mailing Address - Phone:206-385-0399
Mailing Address - Fax:206-384-0389
Practice Address - Street 1:2220 NW MARKET ST STE 100B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4002
Practice Address - Country:US
Practice Address - Phone:206-385-0399
Practice Address - Fax:206-384-0389
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier