Provider Demographics
NPI:1003821760
Name:ZAYAC, EDWARD J (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:ZAYAC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-257-1400
Mailing Address - Fax:210-257-1428
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-257-1400
Practice Address - Fax:210-257-1428
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02583T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103589101Medicaid
TX66939OtherCIDC
TX66939OtherCIDC
410041773Medicare PIN
TX834130Medicare PIN