Provider Demographics
NPI:1104885037
Name:ZELLER MANLEY, AMANDA RAE (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RAE
Last Name:ZELLER MANLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:ZELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4608 S CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3718
Mailing Address - Country:US
Mailing Address - Phone:301-951-0320
Mailing Address - Fax:301-951-0370
Practice Address - Street 1:6900 WISCONSIN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6114
Practice Address - Country:US
Practice Address - Phone:301-951-0320
Practice Address - Fax:301-951-0370
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1930152WP0200X, 152WS0006X, 152WV0400X
DC1000088152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD492230Medicare UPIN