Provider Demographics
NPI:1720052392
Name:CALDER, AMY JO (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY JO
Middle Name:
Last Name:CALDER
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 1:1142 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3538
Mailing Address - Country:US
Mailing Address - Phone:310-323-5095
Mailing Address - Fax:310-323-6046
Practice Address - Street 1:1142 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3538
Practice Address - Country:US
Practice Address - Phone:310-323-5095
Practice Address - Fax:310-323-6046
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12370T152W00000X
UT5870563-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0012370Medicaid
CASD0012370Medicaid
CAV01804Medicare UPIN