Provider Demographics
NPI:1295552164
Name:ZAJAC, LEWIS E (LDO)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:E
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2131
Mailing Address - Country:US
Mailing Address - Phone:727-754-0577
Mailing Address - Fax:
Practice Address - Street 1:1023 23RD ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2131
Practice Address - Country:US
Practice Address - Phone:727-754-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004180332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier