Provider Demographics
NPI:1447698808
Name:RANOLA, AMANDA IBARRA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:IBARRA
Last Name:RANOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5163 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8689
Mailing Address - Country:US
Mailing Address - Phone:925-757-5560
Mailing Address - Fax:925-757-5577
Practice Address - Street 1:5163 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8689
Practice Address - Country:US
Practice Address - Phone:925-757-5560
Practice Address - Fax:925-757-5577
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist