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NPI Code Detail

MEDICARE: MARY KATHRYN P F ZAK O.D.

MEDICARE: MARY KATHRYN P F ZAK O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0618002526VA

General Provider Information

NPI Number : 1821543836
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHRYN P F ZAK O.D.
Provider Business Mailing Address
First Line : 249 ROBINWOOD PL
Second Line :
City : DANVILLE
State : VA
Zip : 24540-6301
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1975 VIRGINIA AVE
Second Line :
City : MARTINSVILLE
State : VA
Zip : 24112-8388
Country : US
Telephone Number : 276-647-3937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2016
Last Update Date : 08/19/2016

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