Provider Demographics
NPI:1952360166
Name:WARDELL, AMY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:WARDELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:131 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1641
Mailing Address - Country:US
Mailing Address - Phone:315-363-4942
Mailing Address - Fax:315-363-4441
Practice Address - Street 1:131 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1641
Practice Address - Country:US
Practice Address - Phone:315-363-4942
Practice Address - Fax:315-363-4441
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0061311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8589Medicare ID - Type Unspecified
U77050Medicare UPIN