1144518051 NPI number — DR. MATTHEW JOHN ZEMANOVICH O.D

Table of content: DR. MATTHEW JOHN ZEMANOVICH O.D (NPI 1144518051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144518051 NPI number — DR. MATTHEW JOHN ZEMANOVICH O.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEMANOVICH
Provider First Name:
MATTHEW
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144518051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 NUECES ST
Provider Second Line Business Mailing Address:
SUITE 70
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701-4195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-472-3937
Provider Business Mailing Address Fax Number:
512-472-3938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 NUECES ST
Provider Second Line Business Practice Location Address:
SUITE 70
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-4195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-472-3937
Provider Business Practice Location Address Fax Number:
512-472-3938
Provider Enumeration Date:
07/12/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  8035TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)