Provider Demographics
NPI:1093834640
Name:ZOLOTOVA, MARINA ALEXANDRA (OD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:ALEXANDRA
Last Name:ZOLOTOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11160 VEIRS MILL RD
Mailing Address - Street 2:LENSCRAFTERS DR. DONNA M. GLENN AND ASSOCIATES
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2538
Mailing Address - Country:US
Mailing Address - Phone:301-949-3960
Mailing Address - Fax:301-949-3962
Practice Address - Street 1:11160 VEIRS MILL RD
Practice Address - Street 2:LENSCRAFTERS DR. DONNA M. GLENN AND ASSOCIATES
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2538
Practice Address - Country:US
Practice Address - Phone:301-949-3960
Practice Address - Fax:301-949-3962
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA2043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist