Healthcare Provider Details

I. General information

NPI: 1568431393
Provider Name (Legal Business Name): KENNETH W OLANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 SMITHVIEW DR
MARYVILLE TN
37803-6100
US

IV. Provider business mailing address

1928 ALCOA HWY SUITE 324
KNOXVILLE TN
37920-1502
US

V. Phone/Fax

Practice location:
  • Phone: 865-681-1234
  • Fax: 865-982-9746
Mailing address:
  • Phone: 865-524-9871
  • Fax: 865-305-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number029068
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: