MEDICARE: BETTY A ZONDAG, OD, PA

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	261Q00000X	Clinic/Center	OPC3413	FL

General Provider Information

NPI Number	:	1518264209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTY A ZONDAG, OD, PA

Provider Business Mailing Address
First Line	:	8960 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3403
Country	:	US
Telephone Number	:	772-337-6376
Fax Number	:	772-337-3977

Provider Business Practice Location Address
First Line	:	8960 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3403
Country	:	US
Telephone Number	:	772-337-6376
Fax Number	:	772-337-3977

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BETTY A ZONDAG
Credential	:	O.D.
Telephone Number	:	772-337-6376

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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