Provider Demographics
NPI:1407548381
Name:THOR, AMY KAY (ABOC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KAY
Last Name:THOR
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4115 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5491
Mailing Address - Country:US
Mailing Address - Phone:920-652-9674
Mailing Address - Fax:920-652-9679
Practice Address - Street 1:4115 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5491
Practice Address - Country:US
Practice Address - Phone:920-652-9674
Practice Address - Fax:920-652-9679
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician