Healthcare Provider Details

I. General information

NPI: 1003944703
Provider Name (Legal Business Name): DR. MICHAEL ZWOLINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 US HIGHWAY 1 S
ST AUGUSTINE FL
32084-4240
US

IV. Provider business mailing address

312 2ND ST
ST AUGUSTINE FL
32084-7307
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-2594
  • Fax: 904-547-2644
Mailing address:
  • Phone: 904-794-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: