Healthcare Provider Details

I. General information

NPI: 1922490382
Provider Name (Legal Business Name): BRIAN ZEMBOWER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E BASELINE RD STE C3
PHOENIX AZ
85042
US

IV. Provider business mailing address

220 N MCKEMY AVE
CHANDLER AZ
85226-2651
US

V. Phone/Fax

Practice location:
  • Phone: 602-269-9771
  • Fax:
Mailing address:
  • Phone: 480-961-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6421
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002257
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: