Provider Demographics
NPI:1144232794
Name:ZINK, GREGORY F (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:ZINK
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 1:12509 CARROLL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 E WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2713
Practice Address - Country:US
Practice Address - Phone:260-424-5656
Practice Address - Fax:260-424-4511
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002715A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083764OtherANTHEM
IN200061280AMedicaid
OH2904870Medicaid
OH2904870Medicaid
IN000000083764OtherANTHEM
IN252850AMedicare PIN
INU57386Medicare UPIN
IN200061280AMedicaid
IN410030304Medicare PIN
IN176220FMedicare PIN