Healthcare Provider Details

I. General information

NPI: 1750959391
Provider Name (Legal Business Name): ZACHARY DEZEEUW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SUMMIT AVE
FT WORTH TX
76102-4413
US

IV. Provider business mailing address

1201 SUMMIT AVE
FT WORTH TX
76102-4413
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-2020
  • Fax:
Mailing address:
  • Phone: 817-332-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberW6611
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberW6611
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: