Provider Demographics
NPI:1396778460
Name:ZWOLENSKY, BRETT EDWARD (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:EDWARD
Last Name:ZWOLENSKY
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1040
Mailing Address - Country:US
Mailing Address - Phone:304-641-9504
Mailing Address - Fax:304-626-7748
Practice Address - Street 1:1 MED CENTER DR
Practice Address - Street 2:EYE CLINIC
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4155
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:304-626-7748
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist