Provider Demographics
NPI:1609118587
Name:HUSTON, AMANDA KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAY
Last Name:HUSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4875 WARD RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1942
Mailing Address - Country:US
Mailing Address - Phone:303-456-9456
Mailing Address - Fax:303-463-7560
Practice Address - Street 1:2373 CENTRAL PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:303-456-9456
Practice Address - Fax:303-463-7560
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COOPT.0002960152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT3044OtherOD STATE LICENSE