Provider Demographics
NPI:1558572370
Name:STEVEN ZELKO
Entity Type:Organization
Organization Name:STEVEN ZELKO
Other - Org Name:OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ZELKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-2618
Mailing Address - Street 1:309 W QUINTO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5318
Mailing Address - Country:US
Mailing Address - Phone:805-687-0955
Mailing Address - Fax:805-682-1314
Practice Address - Street 1:309 W QUINTO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5318
Practice Address - Country:US
Practice Address - Phone:805-687-0955
Practice Address - Fax:805-682-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953760881OtherOLD EIN #
CA0601810001Medicare NSC