Provider Demographics
NPI:1124282041
Name:AWAD AMANI, CATHERINE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARIE
Last Name:AWAD AMANI
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 1:415 HEATHROW CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4736
Mailing Address - Country:US
Mailing Address - Phone:321-438-3500
Mailing Address - Fax:
Practice Address - Street 1:502 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5427
Practice Address - Country:US
Practice Address - Phone:321-727-2020
Practice Address - Fax:321-726-4061
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007304152W00000X
PAOEG002550152W00000X
FLOPC4420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist