Healthcare Provider Details

I. General information

NPI: 1457450850
Provider Name (Legal Business Name): MARK ANTHONY ZAREMBA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NORMANDY DR
PAINESVILLE OH
44077-1615
US

IV. Provider business mailing address

1650 POPLAR LN
PAINESVILLE OH
44077-6126
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-0616
  • Fax: 440-352-0618
Mailing address:
  • Phone: 440-350-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5424
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5424
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: