Provider Demographics
NPI:1164591319
Name:ZUNICH, NICK B (OD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:B
Last Name:ZUNICH
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 1:12000 SNOW RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9314
Mailing Address - Country:US
Mailing Address - Phone:440-885-1060
Mailing Address - Fax:440-885-1079
Practice Address - Street 1:12000 SNOW RD STE 1
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-9314
Practice Address - Country:US
Practice Address - Phone:440-885-1060
Practice Address - Fax:440-885-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 3700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0683630001OtherDURABLE MEDICAL EQUIP
OHZU0696861Medicare ID - Type Unspecified
NDU19573Medicare UPIN