Provider Demographics
NPI:1659474682
Name:NEAL, AMANDA KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAY
Last Name:NEAL
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 1:608 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-4616
Mailing Address - Country:US
Mailing Address - Phone:806-894-6330
Mailing Address - Fax:806-894-2443
Practice Address - Street 1:608 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4616
Practice Address - Country:US
Practice Address - Phone:806-894-6330
Practice Address - Fax:806-894-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6720TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82124QOtherBLUE CROSS BLUE SHIELD
TX8F7828Medicare PIN
TXV06455Medicare UPIN