Healthcare Provider Details

I. General information

NPI: 1750342150
Provider Name (Legal Business Name): ZEN B RONDOWSKY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 MOUNT VERNON RD
DUNWOODY GA
30338-4224
US

IV. Provider business mailing address

1611 MOUNT VERNON RD
DUNWOODY GA
30338-4224
US

V. Phone/Fax

Practice location:
  • Phone: 770-393-0003
  • Fax: 770-393-1557
Mailing address:
  • Phone: 770-393-0003
  • Fax: 770-393-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT001024
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: