Provider Demographics
NPI:1720217854
Name:UMLANDT, AMANDA JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOY
Last Name:UMLANDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1193 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-6780
Mailing Address - Country:US
Mailing Address - Phone:276-935-2292
Mailing Address - Fax:276-935-2993
Practice Address - Street 1:1193 PLAZA DR
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6780
Practice Address - Country:US
Practice Address - Phone:276-935-2292
Practice Address - Fax:276-935-2993
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2627152W00000X
MO201001750152W00000X
CT002811152W00000X
VA0618002020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist