Provider Demographics
NPI:1770748550
Name:MOUSSA, AMY KATHERINE (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHERINE
Last Name:MOUSSA
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 1:895 TRANCAS ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3040
Mailing Address - Country:US
Mailing Address - Phone:707-252-2020
Mailing Address - Fax:707-252-0329
Practice Address - Street 1:901 SUNVALLEY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5816
Practice Address - Country:US
Practice Address - Phone:925-676-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13536 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist