Individual
AMANDA S MISINCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4510 E CACTUS RD, JCPENNEY OPTICAL, PHOENIX, AZ 85032-7702
(602) 996-6833
Mailing address
2206 N 24TH ST, MESA, AZ 85213-2245
(480) 478-9563
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1686
AZ
Other
Enumeration date
06/28/2009
Last updated
01/28/2011
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