Provider Demographics
NPI:1841455052
Name:HATCHER, AMANDA (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:HATCHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TRUDEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1105 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-5035
Mailing Address - Country:US
Mailing Address - Phone:918-775-4524
Mailing Address - Fax:918-775-4992
Practice Address - Street 1:1105 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-5035
Practice Address - Country:US
Practice Address - Phone:918-775-4524
Practice Address - Fax:918-775-4992
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200205150AMedicaid
OKOKB5218Medicare PIN
OK200205150AMedicaid