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General NPI Number Information
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NPI Number | 1518264209
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Entity Type | Organization
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Legal Business Name | BETTY A ZONDAG, OD, PA
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 8960 S FEDERAL HWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3403
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Country | US
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Telephone | 772-337-6376
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Fax | 772-337-3977
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Provider Business Mailing Address
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Address Line | 8960 S FEDERAL HWY
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3403
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Country | US
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Telephone | 772-337-6376
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Fax | 772-337-3977
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETTY A ZONDAG
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Credential | O.D.
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Telephone | 772-337-6376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OPC3413
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License Number State | FL
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