Provider Demographics
NPI:1386622512
Name:SIE, AMANDA HAM (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:HAM
Last Name:SIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1913 JN PEASE PL
Mailing Address - Street 2:STE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4556
Mailing Address - Country:US
Mailing Address - Phone:704-548-9888
Mailing Address - Fax:704-548-0077
Practice Address - Street 1:1913 JN PEASE PL
Practice Address - Street 2:STE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4556
Practice Address - Country:US
Practice Address - Phone:704-548-9888
Practice Address - Fax:704-548-0077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909Z3VMedicaid
NC8909Z3VMedicaid
Z470885HMedicare ID - Type Unspecified