Provider Demographics
NPI:1801100987
Name:EHRGOOD-PERRY, AMANDA (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:EHRGOOD-PERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:EHRGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:601 WALNUT ST STE 210W
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3323
Mailing Address - Country:US
Mailing Address - Phone:215-925-6402
Mailing Address - Fax:215-925-0262
Practice Address - Street 1:601 WALNUT ST STE 210W
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3323
Practice Address - Country:US
Practice Address - Phone:215-925-6402
Practice Address - Fax:215-925-0262
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102529106Medicaid
PA190684Medicare PIN