Healthcare Provider Details

I. General information

NPI: 1043230790
Provider Name (Legal Business Name): RANDAL L ZINK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 N STATE ROUTE 2
NEW MARTINSVILLE WV
26155-2203
US

IV. Provider business mailing address

273 N STATE ROUTE 2
NEW MARTINSVILLE WV
26155-2203
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-5524
  • Fax: 304-455-5532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number856OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: