Provider Demographics
NPI:1467505867
Name:VOLZ, LAURA ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELLEN
Last Name:VOLZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4496 PINE DR
Mailing Address - Street 2:
Mailing Address - City:PEGRAM
Mailing Address - State:TN
Mailing Address - Zip Code:37143-2055
Mailing Address - Country:US
Mailing Address - Phone:615-892-9819
Mailing Address - Fax:
Practice Address - Street 1:4496 PINE DR
Practice Address - Street 2:
Practice Address - City:PEGRAM
Practice Address - State:TN
Practice Address - Zip Code:37143-2055
Practice Address - Country:US
Practice Address - Phone:615-892-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008559Medicaid
IL046008559Medicaid
IL450820Medicare ID - Type Unspecified