Provider Demographics
NPI:1699036764
Name:PELZNER, AMY (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PELZNER
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 1:626 BUCHANAN WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6919
Mailing Address - Country:US
Mailing Address - Phone:916-204-0689
Mailing Address - Fax:
Practice Address - Street 1:705 E BIDWELL ST STE 10
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3315
Practice Address - Country:US
Practice Address - Phone:916-983-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11880T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist