Provider Demographics
NPI:1417197286
Name:ZEAK, DAVID H (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:ZEAK
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2533
Mailing Address - Country:US
Mailing Address - Phone:732-892-3176
Mailing Address - Fax:
Practice Address - Street 1:512 BAY AVE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2533
Practice Address - Country:US
Practice Address - Phone:732-892-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ914156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4834180001Medicare NSC