Provider Demographics
NPI:1841483278
Name:EDWARD ZIKOSKI EYE PROF OF WASHINGTON CROSSING
Entity type:Organization
Organization Name:EDWARD ZIKOSKI EYE PROF OF WASHINGTON CROSSING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZIKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-493-0404
Mailing Address - Street 1:1098 WASHINGTON CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON XING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1343
Mailing Address - Country:US
Mailing Address - Phone:215-493-0404
Mailing Address - Fax:215-493-2033
Practice Address - Street 1:1098 WASHINGTON CROSSING RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON XING
Practice Address - State:PA
Practice Address - Zip Code:18977-1343
Practice Address - Country:US
Practice Address - Phone:215-493-0404
Practice Address - Fax:215-493-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000264152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU05409Medicare UPIN
PA418652Medicare PIN