Provider Demographics
NPI:1679913818
Name:PFAU, ZACHARY (OD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:PFAU
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 1:1110 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4606
Mailing Address - Country:US
Mailing Address - Phone:520-327-5677
Mailing Address - Fax:520-325-2335
Practice Address - Street 1:1110 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-327-5677
Practice Address - Fax:520-325-2335
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2022-10-19
Deactivation Date:2022-09-29
Deactivation Code:
Reactivation Date:2022-10-06
Provider Licenses
StateLicense IDTaxonomies
AZ1918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162078Medicare PIN
AZZ1662079Medicare PIN
AZZ164127Medicare PIN
AZZ162075Medicare PIN
AZZ162076Medicare PIN
AZZ164126Medicare PIN
AZZ164129Medicare PIN
AZZ164125Medicare PIN
AZZ162077Medicare PIN
AZZ164128Medicare PIN