Provider Demographics
NPI:1174183529
Name:CARENZA, AMY BROOKE MACKEY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BROOKE MACKEY
Last Name:CARENZA
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 1:100 PIPER HILL DR STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1616
Mailing Address - Country:US
Mailing Address - Phone:256-997-7058
Mailing Address - Fax:
Practice Address - Street 1:2311 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1531
Practice Address - Country:US
Practice Address - Phone:314-434-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019020522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist