Provider Demographics
NPI:1124212519
Name:ZAKAIM, IRIT M (OD)
Entity type:Individual
Prefix:
First Name:IRIT
Middle Name:M
Last Name:ZAKAIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7439
Mailing Address - Country:US
Mailing Address - Phone:718-386-1818
Mailing Address - Fax:
Practice Address - Street 1:7809 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7439
Practice Address - Country:US
Practice Address - Phone:513-474-4444
Practice Address - Fax:513-474-7915
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1710 DT152W00000X
OH5756/T2670152W00000X
NYTUV7215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11779602OtherCAQH
OH000000547801OtherANTHEM
KY0740709Medicare PIN
OH4219986Medicare PIN
11779602OtherCAQH