Provider Demographics
NPI:1295579498
Name:CONN, ZACHARY (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:CONN
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 BARRET BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-7508
Mailing Address - Country:US
Mailing Address - Phone:270-831-8686
Mailing Address - Fax:270-831-8676
Practice Address - Street 1:1195 BARRET BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-7508
Practice Address - Country:US
Practice Address - Phone:270-831-8686
Practice Address - Fax:270-831-8676
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY293294156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician