Provider Demographics
NPI:1699191809
Name:ZACHARY LEMASTER O.D.
Entity Type:Organization
Organization Name:ZACHARY LEMASTER O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-421-4049
Mailing Address - Street 1:4803 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2605
Mailing Address - Country:US
Mailing Address - Phone:307-421-4049
Mailing Address - Fax:
Practice Address - Street 1:3601 32ND AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5911
Practice Address - Country:US
Practice Address - Phone:701-787-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND715152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN719518Medicare PIN