Healthcare Provider Details

I. General information

NPI: 1528601721
Provider Name (Legal Business Name): ZACHARY BLACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 COMMERCIAL DR
RICHMOND KY
40475-3402
US

IV. Provider business mailing address

64 FERRY ST
WINFIELD WV
25213-9350
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-5830
  • Fax:
Mailing address:
  • Phone: 304-710-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number307113
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: