Provider Demographics
NPI:1063407476
Name:LAHAY, AMY S (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:LAHAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 W AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1461
Mailing Address - Country:US
Mailing Address - Phone:920-806-3005
Mailing Address - Fax:920-806-3004
Practice Address - Street 1:878 W AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1461
Practice Address - Country:US
Practice Address - Phone:920-806-3005
Practice Address - Fax:920-806-3004
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60258Medicare UPIN
WI0282 71018Medicare PIN