Provider Demographics
NPI:1003102757
Name:EPHRAIM, DAVID ZACHARY (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ZACHARY
Last Name:EPHRAIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NOTLEY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6220
Mailing Address - Country:US
Mailing Address - Phone:301-384-6100
Mailing Address - Fax:
Practice Address - Street 1:10518 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2467
Practice Address - Country:US
Practice Address - Phone:301-942-2221
Practice Address - Fax:301-942-6338
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7999538-9934152W00000X
MDTA2283152W00000X
DCOP1000233152W00000X
VA0618002098152W00000X
COOPT0002942152W00000X
IL046010522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist