Provider Demographics
NPI:1275381733
Name:ZOLL, ALYSSA (OD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ZOLL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:ZOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3530
Practice Address - Country:US
Practice Address - Phone:203-845-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist