Provider Demographics
NPI:1679582621
Name:ZAK, ZDENEK (OD)
Entity Type:Individual
Prefix:DR
First Name:ZDENEK
Middle Name:
Last Name:ZAK
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 1:10 CODY ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1801
Mailing Address - Country:US
Mailing Address - Phone:508-943-8855
Mailing Address - Fax:508-943-6914
Practice Address - Street 1:10 CODY ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1801
Practice Address - Country:US
Practice Address - Phone:508-943-8855
Practice Address - Fax:508-943-6914
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0343439Medicaid
MAT59318Medicare UPIN
MA202058Medicare ID - Type Unspecified
MA0343439Medicaid