Provider Demographics
NPI:1376548099
Name:RASMUSSEN, AMY DIANE SMITH (O D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DIANE SMITH
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:DIANE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:O D
Mailing Address - Street 1:7758 CREEKMERE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8942
Mailing Address - Country:US
Mailing Address - Phone:972-335-6863
Mailing Address - Fax:
Practice Address - Street 1:5000 ELDORADO PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8695
Practice Address - Country:US
Practice Address - Phone:972-377-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6837TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L9965Medicare PIN