Healthcare Provider Details

I. General information

NPI: 1730305434
Provider Name (Legal Business Name): JENNIFER SMITH ZOLMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JENNIFER MARIE SMITH

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 TOBIAS GADSON BLVD SUITE 115
CHARLESTON SC
29407-4707
US

IV. Provider business mailing address

PO BOX 80817
CHARLESTON SC
29416-0817
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-2020
  • Fax: 843-763-3937
Mailing address:
  • Phone: 843-556-2020
  • Fax: 843-763-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1413
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: