Provider Demographics
NPI:1013349869
Name:KORTH, AMANDA JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOY
Last Name:KORTH
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 1:87 PAINE STREET SE
Mailing Address - Street 2:STE 3
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1451
Mailing Address - Country:US
Mailing Address - Phone:515-267-7908
Mailing Address - Fax:515-209-2500
Practice Address - Street 1:104 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1347
Practice Address - Country:US
Practice Address - Phone:563-422-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1926DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist