Provider Demographics
NPI:1184733016
Name:ZITKO, PATRICIA (OD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ZITKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3416
Mailing Address - Country:US
Mailing Address - Phone:419-756-8000
Mailing Address - Fax:419-756-2601
Practice Address - Street 1:76 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-0648
Practice Address - Country:US
Practice Address - Phone:419-347-1445
Practice Address - Fax:419-347-8403
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2147886Medicaid
OHZI0867912Medicare ID - Type Unspecified
OHU74800Medicare UPIN