Provider Demographics
NPI:1063651388
Name:DR MICHAEL T KOLARIK OD
Entity Type:Organization
Organization Name:DR MICHAEL T KOLARIK OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KOLARIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-984-6931
Mailing Address - Street 1:286 CHEROKEE PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5153
Mailing Address - Country:US
Mailing Address - Phone:865-984-6931
Mailing Address - Fax:865-983-3937
Practice Address - Street 1:286 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5153
Practice Address - Country:US
Practice Address - Phone:865-984-6931
Practice Address - Fax:865-983-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4635730001Medicare NSC