Provider Demographics
NPI:1275810079
Name:OSWALD, ZACHARY MCLEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:MCLEAN
Last Name:OSWALD
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 1:25 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3323
Mailing Address - Country:US
Mailing Address - Phone:406-683-2020
Mailing Address - Fax:406-683-6409
Practice Address - Street 1:25 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3323
Practice Address - Country:US
Practice Address - Phone:406-683-2020
Practice Address - Fax:406-683-6409
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9885098-9934152W00000X
OR3437ATI152W00000X
IDODP-100231152W00000X
MTOPT-OPT-LIC-3096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist