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General NPI Number Information
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NPI Number | 1699948695
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Entity Type | Individual
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Provider Name | BETTY ZONDAG O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2008
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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 |
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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 | OPC3413
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License Number State | FL
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