Provider Demographics
NPI:1235371469
Name:ZAVODNI, ZACHARY JAMES
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:ZAVODNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2105
Mailing Address - Country:US
Mailing Address - Phone:801-266-2283
Mailing Address - Fax:
Practice Address - Street 1:755 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2105
Practice Address - Country:US
Practice Address - Phone:801-266-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56463207W00000X
UT9089290-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology