Provider Demographics
NPI:1124158506
Name:ZELDES, STEVEN GREGORY (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GREGORY
Last Name:ZELDES
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 1:500 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2169
Mailing Address - Country:US
Mailing Address - Phone:928-289-6224
Mailing Address - Fax:928-289-6292
Practice Address - Street 1:500 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2169
Practice Address - Country:US
Practice Address - Phone:928-289-6224
Practice Address - Fax:928-289-6290
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1247152W00000X
AZ1033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ440462Medicaid
AZT65058Medicare UPIN
AZTEZ67RMedicare PIN
AZ440462Medicaid
AZTEZ69RMedicare PIN
AZTEZ70RMedicare PIN
AZTEZ71RMedicare PIN