Healthcare Provider Details

I. General information

NPI: 1003682964
Provider Name (Legal Business Name): ELIZABETH ZILLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 MILLENNIUM BLVD
CORTLAND OH
44410-9173
US

IV. Provider business mailing address

2016 MILLENNIUM BLVD
CORTLAND OH
44410-9173
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-2210
  • Fax: 330-372-2351
Mailing address:
  • Phone: 330-372-2210
  • Fax: 330-372-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberS.14130
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: