Provider Demographics
NPI:1316982077
Name:ZANOUDAKIS, EMMANUEL (OD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:ZANOUDAKIS
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 1:7448 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6605
Mailing Address - Country:US
Mailing Address - Phone:440-885-0822
Mailing Address - Fax:440-885-7225
Practice Address - Street 1:7448 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6605
Practice Address - Country:US
Practice Address - Phone:440-885-0822
Practice Address - Fax:440-885-7225
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3903152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0685021Medicaid
T48559Medicare UPIN
OH0685021Medicaid