Provider Demographics
NPI:1487711057
Name:ZAKI, VICTOR BOUTROS (OD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:BOUTROS
Last Name:ZAKI
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 1:1595 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2222
Mailing Address - Country:US
Mailing Address - Phone:617-964-7963
Mailing Address - Fax:
Practice Address - Street 1:250 GRANITE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2804
Practice Address - Country:US
Practice Address - Phone:781-356-0111
Practice Address - Fax:781-848-6880
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005001031OtherAETNA
MAAA31492OtherHARVARD PILGRIM HEALTH PL
MAMA3908OtherEYEMED
MAW16040OtherBLUE CROSS BLUE SHIELD
MA0369373Medicaid
MAZAW17012Medicare ID - Type Unspecified