Healthcare Provider Details

I. General information

NPI: 1255111985
Provider Name (Legal Business Name): VERENA ZENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W 20TH ST STE A
MERCED CA
95340-3639
US

IV. Provider business mailing address

3617 BAYBORO DR
MODESTO CA
95357-1308
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-2335
  • Fax:
Mailing address:
  • Phone: 209-672-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: