Provider Demographics
NPI:1578947289
Name:HASSEY, AMANDA COLEEN (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:COLEEN
Last Name:HASSEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:COLEEN
Other - Last Name:PALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:12 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1102
Mailing Address - Country:US
Mailing Address - Phone:215-298-2694
Mailing Address - Fax:
Practice Address - Street 1:615 W GERMANTOWN PIKE # 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462
Practice Address - Country:US
Practice Address - Phone:610-397-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13584914OtherCAQH NUMBER