Healthcare Provider Details

I. General information

NPI: 1144319955
Provider Name (Legal Business Name): RICHARD ZAVODA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 N 2ND ST
HAMILTON MT
59840-2503
US

IV. Provider business mailing address

239 N 2ND ST
HAMILTON MT
59840-2503
US

V. Phone/Fax

Practice location:
  • Phone: 406-961-9611
  • Fax: 406-961-9014
Mailing address:
  • Phone: 406-961-9611
  • Fax: 406-961-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4395
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4258
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: