Provider Demographics
NPI:1720640246
Name:GERMAN, ZACHARY (OD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:GERMAN
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 1:2845 N PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1077
Mailing Address - Country:US
Mailing Address - Phone:937-776-8139
Mailing Address - Fax:
Practice Address - Street 1:5164 CAPITOL BLVD SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4442
Practice Address - Country:US
Practice Address - Phone:360-357-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3548152W00000X
AZ2457152W00000X
WAOD61189395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOD61189395OtherWA STATE OD LICENSE