MEDICARE: ZACHARY FROST 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	ATI4691	OR

General Provider Information

NPI Number	:	1558133991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY FROST OD

Provider Business Mailing Address
First Line	:	1150 SE LEANDER ST
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4881
Country	:	US
Telephone Number	:	206-819-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	10970 SW BARNES RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5368
Country	:	US
Telephone Number	:	503-214-1396
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	11/16/2023

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