Provider Demographics
NPI:1962493734
Name:WARD, AMY B (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:B
Last Name:WARD
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 1:7201 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7101
Mailing Address - Country:US
Mailing Address - Phone:407-671-3100
Mailing Address - Fax:407-671-8245
Practice Address - Street 1:7201 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7101
Practice Address - Country:US
Practice Address - Phone:407-671-3100
Practice Address - Fax:407-671-8245
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084780100Medicaid
FL4519167OtherAETNA PROVIDER #
FL2285031OtherUNITED HEALTHCARE PROVIDE
FL20325OtherBLUE CROSS BLUE SHIELD
FLU27694Medicare UPIN
FL084780100Medicaid