Provider Demographics
NPI:1528288669
Name:LAKUSTA, AMANDA RICHARDS (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RICHARDS
Last Name:LAKUSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:B
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:112 N AKERS ST STE A
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5121
Mailing Address - Country:US
Mailing Address - Phone:559-733-4372
Mailing Address - Fax:559-733-1758
Practice Address - Street 1:112 N AKERS ST STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5121
Practice Address - Country:US
Practice Address - Phone:559-733-4372
Practice Address - Fax:559-733-1758
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254763207W00000X
MDD79626207W00000X
CAC154815207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology