Provider Demographics
NPI:1962464446
Name:ZANELLA, PETER JOSEPH JR (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:ZANELLA
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2111 KIRKWOOD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1461
Mailing Address - Country:US
Mailing Address - Phone:817-416-2010
Mailing Address - Fax:817-416-2013
Practice Address - Street 1:2111 KIRKWOOD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1461
Practice Address - Country:US
Practice Address - Phone:817-416-2010
Practice Address - Fax:817-416-2013
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6868T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68165Medicare UPIN
TX8F4740Medicare PIN