Provider Demographics
NPI:1801903968
Name:ZITKO, PHILIP RONALD (OD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:RONALD
Last Name:ZITKO
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 1:466 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3416
Mailing Address - Country:US
Mailing Address - Phone:419-756-8000
Mailing Address - Fax:419-756-2601
Practice Address - Street 1:76 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1206
Practice Address - Country:US
Practice Address - Phone:419-347-1445
Practice Address - Fax:419-347-8403
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0844626Medicaid
OHZI0728223Medicare ID - Type Unspecified
OH0844626Medicaid