MEDICARE: DR. DONALD ROBERT ZVANUT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	U51564	CA
2	152W00000X	Optometrist	8642TPG	CA

General Provider Information

NPI Number	:	1336211804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ROBERT ZVANUT OD

Provider Business Mailing Address
First Line	:	225 W MADISON AVE
Second Line	:	SUITE 1
City	:	EL CAJON
State	:	CA
Zip	:	92020
Country	:	US
Telephone Number	:	619-442-0844
Fax Number	:	619-442-7399

Provider Business Practice Location Address
First Line	:	7339 EL CAJON BLVD STE JK
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-7435
Country	:	US
Telephone Number	:	661-972-2846
Fax Number	:	619-722-8465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/16/2022

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