Healthcare Provider Details

I. General information

NPI: 1225477870
Provider Name (Legal Business Name): LORI BETH ZINTAK O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 S ROBERTS RD
HICKORY HILLS IL
60457-2326
US

IV. Provider business mailing address

9400 S ROBERTS RD
HICKORY HILLS IL
60457-2326
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: