Provider Demographics
NPI:1770544801
Name:HITZEMAN, AMY APISA (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:APISA
Last Name:HITZEMAN
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 1:79 LAYING UP CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5257
Mailing Address - Country:US
Mailing Address - Phone:808-778-7243
Mailing Address - Fax:
Practice Address - Street 1:4180 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8600
Practice Address - Country:US
Practice Address - Phone:702-732-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI522T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist