1457559593 NPI number — DR. AMANDA MEREDITH HOBBS MERCER O.D.

Table of content: DR. AMANDA MEREDITH HOBBS MERCER O.D. (NPI 1457559593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457559593 NPI number — DR. AMANDA MEREDITH HOBBS MERCER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCER
Provider First Name:
AMANDA
Provider Middle Name:
MEREDITH HOBBS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOBBS
Provider Other First Name:
AMANDA
Provider Other Middle Name:
MEREDITH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457559593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 ADAMS AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-545-9162
Provider Business Mailing Address Fax Number:
714-241-1345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 ADAMS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92626-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-545-9162
Provider Business Practice Location Address Fax Number:
714-241-1345
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  13629 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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