Healthcare Provider Details

I. General information

NPI: 1710853098
Provider Name (Legal Business Name): DOMINICA Y DZAKAH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14005 RESEARCH BLVD STE 100
AUSTIN TX
78717-5381
US

IV. Provider business mailing address

14005 RESEARCH BLVD STE 100
AUSTIN TX
78717-5381
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-7070
  • Fax:
Mailing address:
  • Phone: 512-257-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11552TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: