Provider Demographics
NPI:1013041680
Name:ZASTROW, FLOYD ELLIS (OD)
Entity Type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:ELLIS
Last Name:ZASTROW
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 1:404 W PINE ST
Mailing Address - Street 2:STE #1
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-2048
Mailing Address - Country:US
Mailing Address - Phone:209-369-2078
Mailing Address - Fax:
Practice Address - Street 1:404 W PINE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2048
Practice Address - Country:US
Practice Address - Phone:209-369-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0032690Medicare ID - Type Unspecified
T09326Medicare UPIN