Provider Demographics
NPI:1346432291
Name:ZUBER, TODD KENNETH (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:KENNETH
Last Name:ZUBER
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 1:862 CAMPFIRE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1992
Mailing Address - Country:US
Mailing Address - Phone:312-371-2258
Mailing Address - Fax:970-416-6129
Practice Address - Street 1:4705 WEITZEL STREET
Practice Address - Street 2:OPTOMETRY CLINIC
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-8959
Practice Address - Country:US
Practice Address - Phone:970-416-6130
Practice Address - Fax:970-416-6129
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3088-035152W00000X
CO2650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04573277Medicaid
WI38632400Medicaid
COCO301858Medicare PIN
WIP00455306Medicare PIN
WI60735OtherDEAN HEALTH INSURANCE
WI000647795Medicare PIN
WI001247810Medicare PIN