Provider Demographics
NPI:1457639213
Name:HIKIN, AMANDA WELS (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:WELS
Last Name:HIKIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:WELS
Other - Last Name:ORGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1234 7TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-395-5778
Mailing Address - Fax:
Practice Address - Street 1:1234 7TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-395-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist