Provider Demographics
NPI:1891757837
Name:FRIESS, AMANDA M (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:FRIESS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:BRULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:51 LENFANT CT
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1668
Mailing Address - Country:US
Mailing Address - Phone:484-842-1445
Mailing Address - Fax:
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:NEMOURS DUPONT PEDIATRICS
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-5040
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4024152W00000X
PAOEG000273152W00000X
DEI3-0001328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist