Individual
DR. AMANDA J MATAYA PIETIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
311 N ANKENY BLVD, ANKENY, IA 50023-1711
(515) 964-1671
(515) 964-1714
Mailing address
311 N ANKENY BLVD, ANKENY, IA 50023-1711
(515) 964-1671
(515) 964-1714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002401
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48179001
MEDICARE ID-TYPE UNSPECIF
IA
01
—
71726
BLUE CROSS
IA
Enumeration date
08/06/2007
Last updated
02/12/2013
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