Provider Demographics
NPI:1588651772
Name:ZARYBNISKY, JACK G (OD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:G
Last Name:ZARYBNISKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1970 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2439
Mailing Address - Country:US
Mailing Address - Phone:208-678-3539
Mailing Address - Fax:208-678-2949
Practice Address - Street 1:1970 OVERLAND AVE.
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2439
Practice Address - Country:US
Practice Address - Phone:208-678-3539
Practice Address - Fax:208-678-2949
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist