Organization
AMY H FORESTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY H CHAMP O.D. (DOCTOR OF OPTOMETRY)
(928) 541-0615
Entity
Organization
Contact information
Practice address
3400 GATEWAY BLVD, PRESCOTT, AZ 86303-6848
(928) 778-4402
(928) 778-4402
Mailing address
2053 PLATEAU, PRESCOTT, AZ 86305-2169
(928) 541-0615
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
967
AZ
Other
Enumeration date
01/11/2011
Last updated
01/11/2011
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