Provider Demographics
NPI:1134227325
Name:THICH, AMY (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:THICH
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 1:1844 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2517
Mailing Address - Country:US
Mailing Address - Phone:415-409-0888
Mailing Address - Fax:668-646-0388
Practice Address - Street 1:1844 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2517
Practice Address - Country:US
Practice Address - Phone:415-409-0888
Practice Address - Fax:866-864-6038
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12365T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0123650Medicaid
CASD0123650Medicaid