Provider Demographics
NPI:1568431393
Name:OLANDER, KENNETH W (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:OLANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY
Mailing Address - Street 2:SUITE 324
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1502
Mailing Address - Country:US
Mailing Address - Phone:865-524-9871
Mailing Address - Fax:865-305-6695
Practice Address - Street 1:622 SMITHVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-681-1234
Practice Address - Fax:865-982-9746
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN029068207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0189280OtherCIGNA
TN3812701Medicaid
0840032OtherUNITED HEALTHCARE
4016420OtherAETNA
180029273OtherRAILROAD MEDICARE
3063767OtherBLUE CROSS BLUE SHIELD
100023403OtherPHP
3333333OtherUMWA
TN0112OtherJOHN DEERE
TN3812701Medicaid
0840032OtherUNITED HEALTHCARE
TN3812702Medicare ID - Type Unspecified