Individual
DR. AMANDA JESSIE BISSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2004025214
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
319102232
—
MO
01
—
P00374002
RAILROAD MEDICARE
MO
Enumeration date
06/23/2005
Last updated
11/18/2014
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