Provider Demographics
NPI:1821180571
Name:DUBOUR, ZANE FREDERICK (OD,MS)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:FREDERICK
Last Name:DUBOUR
Suffix:
Gender:M
Credentials:OD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9424
Mailing Address - Country:US
Mailing Address - Phone:978-249-9212
Mailing Address - Fax:
Practice Address - Street 1:285 MAIN ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4303
Practice Address - Country:US
Practice Address - Phone:978-342-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA43490OtherCIGNA
MAW15413OtherBLUR CROSS BLUE SHIELD
MA0341061Medicaid
MA152147OtherHARVARD PILGRIM
MA67948OtherFALLON CHP
MA67948OtherFALLON CHP
MA152147OtherHARVARD PILGRIM