Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 02583T | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 02583T | TX |
NPI | 1003821760 |
---|---|
Provider Name | Edward J Zayac |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 06/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103589101 | (05) | TX |
66939 | CIDC (01) | TX |