Provider Demographics
NPI:1841743234
Name:YOUNGER, AMANDA LUCETTE (OD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LUCETTE
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9979 WINGHAVEN BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3628
Mailing Address - Country:US
Mailing Address - Phone:636-695-8555
Mailing Address - Fax:636-695-8555
Practice Address - Street 1:4702 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63376-2883
Practice Address - Country:US
Practice Address - Phone:636-244-5378
Practice Address - Fax:636-244-5378
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2748152W00000X
MO2017009254152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist