Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3269 | CA |
NPI | 1013041680 |
---|---|
Provider Name | Dr. Floyd Ellis Zastrow |
First Address | Lodi, CA 95240-2048 |
Second Address | Lodi, CA 95240-2048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T09326 | (02) |