Provider Demographics
NPI:1417153917
Name:CHESTER ZARNOCH
Entity Type:Organization
Organization Name:CHESTER ZARNOCH
Other - Org Name:SOUTH SUBURBAN OPHTHALMOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ZARNOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-749-2050
Mailing Address - Street 1:175 DERBY ST
Mailing Address - Street 2:SUITE 38
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4007
Mailing Address - Country:US
Mailing Address - Phone:781-749-2050
Mailing Address - Fax:781-749-2125
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:SUITE 38
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4007
Practice Address - Country:US
Practice Address - Phone:781-749-2050
Practice Address - Fax:781-749-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2060388Medicaid
MA2060388Medicaid
MAA66993Medicare UPIN