Provider Demographics
NPI:1730305434
Name:ZOLMAN, JENNIFER SMITH (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SMITH
Last Name:ZOLMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 80817
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0817
Mailing Address - Country:US
Mailing Address - Phone:843-556-2020
Mailing Address - Fax:843-763-3937
Practice Address - Street 1:1470 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4707
Practice Address - Country:US
Practice Address - Phone:843-556-2020
Practice Address - Fax:843-763-3937
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC1413OtherSC OPTOMETRIC LICENSE