Provider Demographics
NPI:1801065578
Name:JOHN D. ZDRAL, M.D., INC.
Entity type:Organization
Organization Name:JOHN D. ZDRAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZDRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-879-7372
Mailing Address - Street 1:301 W BASTANCHURY RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3419
Mailing Address - Country:US
Mailing Address - Phone:714-879-7372
Mailing Address - Fax:714-879-4301
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:SUITE 10
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3419
Practice Address - Country:US
Practice Address - Phone:714-879-7372
Practice Address - Fax:714-879-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80899332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1168220001Medicare NSC