Provider Demographics
NPI:1598498503
Name:MIKHAEIL, AMGAD (OD)
Entity Type:Individual
Prefix:DR
First Name:AMGAD
Middle Name:
Last Name:MIKHAEIL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 HAMILTON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1429
Mailing Address - Country:US
Mailing Address - Phone:615-705-8808
Mailing Address - Fax:
Practice Address - Street 1:3035 HAMILTON CHURCH RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1429
Practice Address - Country:US
Practice Address - Phone:615-705-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty