Provider Demographics
NPI:1548931413
Name:WALSH, AMANDA JEAN (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEAN
Last Name:WALSH
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:27724 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6653
Mailing Address - Country:US
Mailing Address - Phone:949-835-0422
Mailing Address - Fax:949-583-0417
Practice Address - Street 1:27724 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6653
Practice Address - Country:US
Practice Address - Phone:949-583-0422
Practice Address - Fax:949-583-0417
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA34973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist