Individual
AMY J ATHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3360 PENTAGON BLVD, BEAVERCREEK, OH 45431-1702
(937) 426-4638
Mailing address
3360 PENTAGON BLVD, BEAVERCREEK, OH 45431-1702
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OP.017146
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OP.017146-S
—
OH
Enumeration date
02/17/2023
Last updated
02/17/2023
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