=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861455636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID A. ZELMAN O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2006
-----------------------------------------------------
Last Update Date | 10/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2972 CHAIN BRIDGE RD
-----------------------------------------------------
City | OAKTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22124-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-255-1533
-----------------------------------------------------
Fax | 703-255-3377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2972 CHAIN BRIDGE RD
-----------------------------------------------------
City | OAKTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22124-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-255-1533
-----------------------------------------------------
Fax | 703-255-3377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 601000643
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OP382
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------