Healthcare Provider Details

I. General information

NPI: 1538471560
Provider Name (Legal Business Name): MARY ANN JOY ZASTROW O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NICOLLET MALL STE 260
MINNEAPOLIS MN
55402-7023
US

IV. Provider business mailing address

800 NICOLLET MALL STE 260
MINNEAPOLIS MN
55402-7023
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-3937
  • Fax: 612-359-0607
Mailing address:
  • Phone: 612-333-3937
  • Fax: 612-359-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3211
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: