Healthcare Provider Details

I. General information

NPI: 1053498691
Provider Name (Legal Business Name): MAX E ZOLMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 CLINTON HWY
KNOXVILLE TN
37912-1020
US

IV. Provider business mailing address

7346 OXMOOR RD
KNOXVILLE TN
37931-1842
US

V. Phone/Fax

Practice location:
  • Phone: 865-938-6769
  • Fax:
Mailing address:
  • Phone: 865-938-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD936
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: