Provider Demographics
NPI:1578182192
Name:SOUSA, ZACHARY W (OD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:W
Last Name:SOUSA
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 1:129 HASKELL ST # 1
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-4512
Mailing Address - Country:US
Mailing Address - Phone:508-493-5494
Mailing Address - Fax:
Practice Address - Street 1:15 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5805
Practice Address - Country:US
Practice Address - Phone:508-336-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist