Provider Demographics
NPI:1174617757
Name:JOSEPH J. ZELASKO OD PC
Entity type:Organization
Organization Name:JOSEPH J. ZELASKO OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZELASKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-475-0374
Mailing Address - Street 1:4826 TACOMA MALL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7108
Mailing Address - Country:US
Mailing Address - Phone:253-475-0374
Mailing Address - Fax:253-475-9291
Practice Address - Street 1:4826 TACOMA MALL BLVD STE A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7108
Practice Address - Country:US
Practice Address - Phone:253-475-0374
Practice Address - Fax:253-475-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD0001689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031144Medicaid
WA2008811Medicaid
WA2031151Medicaid
WA=========OtherTAX ID NUMBER
WAT89040Medicare UPIN