Provider Demographics
NPI:1326391731
Name:HOM, AMY (DVM DACVO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HOM
Suffix:
Gender:F
Credentials:DVM DACVO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 W MAIN ST
Mailing Address - Street 2:SUITE Q
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1602
Mailing Address - Country:US
Mailing Address - Phone:630-444-0393
Mailing Address - Fax:630-444-0394
Practice Address - Street 1:2002 W MAIN ST
Practice Address - Street 2:SUITE Q
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1602
Practice Address - Country:US
Practice Address - Phone:630-444-0393
Practice Address - Fax:630-444-0394
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090009203174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian