Provider Demographics
NPI:1609990332
Name:STAMM, AMY KRISTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:KRISTIN
Last Name:STAMM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0208
Mailing Address - Country:US
Mailing Address - Phone:814-677-2685
Mailing Address - Fax:814-677-2686
Practice Address - Street 1:3216 STATE ROUTE 257
Practice Address - Street 2:DUAWL PROFESSIONAL PLAZA #7
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-0208
Practice Address - Country:US
Practice Address - Phone:814-677-2685
Practice Address - Fax:814-677-2686
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167600OtherLUXOTTICA PROVIDER ID
PA397485OtherNVA
PA007698243 0003Medicaid
PAST645829OtherBLUE CROSS BLUE SHIELD
PA9176346OtherUPMC DORAL
PAST645829OtherBLUE CROSS BLUE SHIELD