Provider Demographics
NPI:1164914461
Name:VINOGRADOV, AMY H (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:VINOGRADOV
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 1:334 HIGHWAY 92 S STE 7
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4578
Mailing Address - Country:US
Mailing Address - Phone:865-397-9991
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:334 HIGHWAY 92 S STE 7
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4578
Practice Address - Country:US
Practice Address - Phone:865-397-9991
Practice Address - Fax:865-940-1401
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT-236-TA-B19152W00000X
TN3537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist