Provider Demographics
NPI:1427010263
Name:ZEBROWSKI, MARK S (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ZEBROWSKI
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 1:1319 W STATE HIGHWAY 114
Mailing Address - Street 2:STE 320
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8617
Mailing Address - Country:US
Mailing Address - Phone:817-421-9705
Mailing Address - Fax:817-421-9716
Practice Address - Street 1:1319 W STATE HIGHWAY 114
Practice Address - Street 2:SUITE 320
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8617
Practice Address - Country:US
Practice Address - Phone:817-421-9705
Practice Address - Fax:817-421-9716
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2015-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5764TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00322065OtherMEDICARE RAILROAD
80790QOtherBLUE CROSS BLUE SHIELD
TX912154306OtherTIN FOR UHC & CIGNA
TXP00322065OtherMEDICARE RAILROAD
TX8D4330Medicare PIN
TX912154306OtherTIN FOR UHC & CIGNA