Healthcare Provider Details

I. General information

NPI: 1174619829
Provider Name (Legal Business Name): EDWARD W. ZIKOSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 HUNTINGDON PIKE
ROCKLEDGE PA
19046-4451
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 156-639-6302
  • Fax: 215-663-9038
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000264
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOEG000264
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: