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General NPI Number Information
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NPI Number | 1063651388
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Entity Type | Organization
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Legal Business Name | DR MICHAEL T KOLARIK OD
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 286 CHEROKEE PROFESSIONAL PARK
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City | MARYVILLE
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State | TN
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Zip | 37804-5153
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Country | US
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Telephone | 865-984-6931
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Fax | 865-983-3937
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Provider Business Mailing Address
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Address Line | 286 CHEROKEE PROFESSIONAL PARK
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City | MARYVILLE
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State | TN
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Zip | 37804-5153
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Country | US
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Telephone | 865-984-6931
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Fax | 865-983-3937
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL T KOLARIK
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Credential | OD
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Telephone | 865-984-6931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD0000000726
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License Number State | TN
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