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General NPI Number Information
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NPI Number | 1104349935
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Entity Type | Individual
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Provider Name | ZACHARY KYLE BIRD OD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 2421 VESTAL PKWY E # 5
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City | VESTAL
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State | NY
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Zip | 13850-2066
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Country | US
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Telephone | 607-217-5169
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 W ARROWHEAD CLUBHOUSE DR APT 2006
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City | GLENDALE
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State | AZ
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Zip | 85308-8823
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Country | US
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Telephone | 480-543-9647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 008670
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License Number State | NY
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