Provider Demographics
NPI:1699342691
Name:CUSHING, AMANDA JEANNE HORROCKS (OD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEANNE HORROCKS
Last Name:CUSHING
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 1:20 S 850 W STE 3
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3393
Mailing Address - Country:US
Mailing Address - Phone:435-635-7766
Mailing Address - Fax:
Practice Address - Street 1:20 S 850 W STE 3
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3393
Practice Address - Country:US
Practice Address - Phone:435-635-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12298268-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist