Individual
AMY H CHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3192 WILLOW CREEK RD, PRESCOTT, AZ 86301-6610
(928) 778-3950
Mailing address
3192 WILLOW CREEK RD, PRESCOTT, AZ 86301-6610
(928) 778-3950
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0967
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
437732
—
AZ
Enumeration date
05/02/2006
Last updated
04/20/2016
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