Provider Demographics
NPI:1215370143
Name:ZAJAC, KATHERINE HASTINGS (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:HASTINGS
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 STATE ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4113
Mailing Address - Country:US
Mailing Address - Phone:330-678-0201
Mailing Address - Fax:330-678-4272
Practice Address - Street 1:2013 STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4113
Practice Address - Country:US
Practice Address - Phone:330-678-0201
Practice Address - Fax:330-678-4272
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6200 T3115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108722Medicaid
OH0108722Medicaid