Provider Demographics
NPI:1588660351
Name:FICHTER, AMANDA SUE (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:FICHTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N GRANT AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2671
Mailing Address - Country:US
Mailing Address - Phone:302-655-3388
Mailing Address - Fax:302-655-2199
Practice Address - Street 1:1100 N GRANT AVE
Practice Address - Street 2:STE A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2671
Practice Address - Country:US
Practice Address - Phone:302-655-3388
Practice Address - Fax:302-655-2199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000802822Medicaid
U67432Medicare UPIN
DE0000802822Medicaid