Provider Demographics
NPI:1558460030
Name:SENICA, AMY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:SENICA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:522 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6857
Mailing Address - Country:US
Mailing Address - Phone:314-567-7771
Mailing Address - Fax:314-567-7774
Practice Address - Street 1:522 N NEW BALLAS RD
Practice Address - Street 2:SUITE 113
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6857
Practice Address - Country:US
Practice Address - Phone:314-567-7771
Practice Address - Fax:314-567-7774
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12536152W00000X
MO200803421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist