Provider Demographics
NPI:1528247236
Name:DR. MARK ZEBROWSKI OD, PA
Entity type:Organization
Organization Name:DR. MARK ZEBROWSKI OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZEBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-421-9705
Mailing Address - Street 1:1319 W ST HWY 114
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8617
Mailing Address - Country:US
Mailing Address - Phone:817-421-9705
Mailing Address - Fax:817-421-9716
Practice Address - Street 1:1319 W ST HWY 114
Practice Address - Street 2:SUITE 320
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8617
Practice Address - Country:US
Practice Address - Phone:817-421-9705
Practice Address - Fax:817-421-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5764T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00350WMedicare PIN