Individual
AMANDA POWERS HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
200 STEIN PLZ, SUITE 1-340, LOS ANGELES, CA 90095-0001
(310) 825-5000
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 825-5000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT14369
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OPT143690
—
CA
Enumeration date
07/06/2011
Last updated
11/05/2020
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