Healthcare Provider Details

I. General information

NPI: 1417197286
Provider Name (Legal Business Name): DAVID H ZEAK OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 BAY AVE
PT PLEASANT BEACH NJ
08742-2533
US

IV. Provider business mailing address

512 BAY AVE
PT PLEASANT BEACH NJ
08742-2533
US

V. Phone/Fax

Practice location:
  • Phone: 732-892-3176
  • Fax:
Mailing address:
  • Phone: 732-892-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number914
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: