Provider Demographics
NPI:1871758045
Name:ZWANZIGER, BRIAN JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:ZWANZIGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2004
Mailing Address - Country:US
Mailing Address - Phone:580-765-3379
Mailing Address - Fax:580-765-6323
Practice Address - Street 1:521 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2004
Practice Address - Country:US
Practice Address - Phone:580-765-3379
Practice Address - Fax:580-765-6323
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5250Medicare PIN