Individual
DR. AMANDA J STOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
280 N PHELPS AVE, ROCKFORD, IL 61108-2498
(815) 986-1900
(815) 986-1902
Mailing address
16800 WEST CLEVELAND AVE, NEW BERLIN, WI 53151-3533
(262) 432-2005
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009775
IL
152W00000X
Optometrist
3024035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WI9775
EYEMED VISION NO.
—
Enumeration date
04/27/2006
Last updated
12/27/2007
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