Provider Demographics
NPI:1104178763
Name:SAPPINGTON, AMANDA (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:SAPPINGTON
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 1:3406 4TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4357
Mailing Address - Country:US
Mailing Address - Phone:806-884-2743
Mailing Address - Fax:806-677-0177
Practice Address - Street 1:3406 4TH AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4357
Practice Address - Country:US
Practice Address - Phone:806-884-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8095T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX428715Medicare PIN