Provider Demographics
NPI:1902105075
Name:KORTUM, MEGAN DILLMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:DILLMAN
Last Name:KORTUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JEANELLE
Other - Last Name:DILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 GUNBARREL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3192
Mailing Address - Country:US
Mailing Address - Phone:423-832-2020
Mailing Address - Fax:
Practice Address - Street 1:1720 GUNBARREL RD STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-832-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist