Provider Demographics
NPI:1174619829
Name:ZIKOSKI, EDWARD W (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:ZIKOSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:515 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4451
Practice Address - Country:US
Practice Address - Phone:156-639-6302
Practice Address - Fax:215-663-9038
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG000264152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
418652Medicare ID - Type Unspecified
PA05409Medicare UPIN