Provider Demographics
NPI:1538471560
Name:ZASTROW, MARY ANN JOY (OD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:JOY
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 NICOLLET MALL STE 260
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-7023
Mailing Address - Country:US
Mailing Address - Phone:612-333-3937
Mailing Address - Fax:612-359-0607
Practice Address - Street 1:800 NICOLLET MALL STE 260
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-7023
Practice Address - Country:US
Practice Address - Phone:612-333-3937
Practice Address - Fax:612-359-0607
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist