Provider Demographics
NPI:1265740526
Name:ZHUCHENKO, ELENA Y (OD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:Y
Last Name:ZHUCHENKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 N BEALE RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6107
Mailing Address - Country:US
Mailing Address - Phone:530-743-8792
Mailing Address - Fax:530-743-8792
Practice Address - Street 1:5777 GREENBACK LN
Practice Address - Street 2:100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2013
Practice Address - Country:US
Practice Address - Phone:916-231-0034
Practice Address - Fax:916-231-0038
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist