Provider Demographics
NPI:1750342150
Name:RONDOWSKY, ZEN B (OD)
Entity type:Individual
Prefix:DR
First Name:ZEN
Middle Name:B
Last Name:RONDOWSKY
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 1:1611 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4224
Mailing Address - Country:US
Mailing Address - Phone:770-393-0003
Mailing Address - Fax:770-393-1557
Practice Address - Street 1:1611 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4224
Practice Address - Country:US
Practice Address - Phone:770-393-0003
Practice Address - Fax:770-393-1557
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001024152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52155623002OtherBCBS
GAT97809Medicare UPIN
GA41ZCDZVMedicare PIN