Provider Demographics
NPI:1063599884
Name:ZEBROWSKI, JOHN SHAVER (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SHAVER
Last Name:ZEBROWSKI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 JOHN BEN SHEPPERD PKWY STE 17A
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1952
Mailing Address - Country:US
Mailing Address - Phone:432-366-9695
Mailing Address - Fax:432-366-2645
Practice Address - Street 1:1541 JOHN BEN SHEPPERD PKWY STE 17A
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1952
Practice Address - Country:US
Practice Address - Phone:432-366-9695
Practice Address - Fax:432-366-2645
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1296360001Medicare NSC