Healthcare Provider Details

I. General information

NPI: 1184596116
Provider Name (Legal Business Name): ZAKARIAH MIKOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 45TH ST STE 101
MUNSTER IN
46321-2939
US

IV. Provider business mailing address

30 E HURON ST APT 4606
CHICAGO IL
60611-4725
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-6226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004672A
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: