Healthcare Provider Details

I. General information

NPI: 1841483278
Provider Name (Legal Business Name): EDWARD ZIKOSKI EYE PROF OF WASHINGTON CROSSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 WASHINGTON CROSSING RD
WASHINGTON XING PA
18977-1343
US

IV. Provider business mailing address

1098 WASHINGTON CROSSING RD
WASHINGTON XING PA
18977-1343
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-0404
  • Fax: 215-493-2033
Mailing address:
  • Phone: 215-493-0404
  • Fax: 215-493-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDWARD W. ZIKOSKI
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 215-493-0404