=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518940485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID W ZEHNDER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 02/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1832 CASTLETON WAY
-----------------------------------------------------
City | DELAWARE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43015-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-363-2015
-----------------------------------------------------
Fax | 740-369-2408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1832 CASTLETON WAY
-----------------------------------------------------
City | DELAWARE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43015-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-363-2015
-----------------------------------------------------
Fax | 740-369-2408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3904T713
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------