Provider Demographics
NPI:1467644542
Name:ZACHARIAS, YVETTE MARIE (COA, ABOC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARIE
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:COA, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7581 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3536
Mailing Address - Country:US
Mailing Address - Phone:586-260-9115
Mailing Address - Fax:
Practice Address - Street 1:7581 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3536
Practice Address - Country:US
Practice Address - Phone:586-260-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI97281156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant