Provider Demographics
NPI:1003021205
Name:AMUNDSEN, DEAN KENTON (OD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:KENTON
Last Name:AMUNDSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2460 N PONDEROSA DR
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2398
Mailing Address - Country:US
Mailing Address - Phone:805-482-1136
Mailing Address - Fax:805-388-8499
Practice Address - Street 1:2460 N PONDEROSA DR
Practice Address - Street 2:SUITE A-101
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2398
Practice Address - Country:US
Practice Address - Phone:805-482-1136
Practice Address - Fax:805-388-8499
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7925 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist