Provider Demographics
NPI:1871002170
Name:BAUMFALK, ZACHERY (OD)
Entity Type:Individual
Prefix:
First Name:ZACHERY
Middle Name:
Last Name:BAUMFALK
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 1:5001 O ST STE F
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1919
Mailing Address - Country:US
Mailing Address - Phone:531-484-4043
Mailing Address - Fax:531-484-4143
Practice Address - Street 1:5001 O ST STE F
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1919
Practice Address - Country:US
Practice Address - Phone:531-484-4043
Practice Address - Fax:531-484-4143
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9353T152W00000X
IA091285152W00000X
NE1481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist