Provider Demographics
NPI:1144319955
Name:ZAVODA, RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:ZAVODA
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 1:239 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2503
Mailing Address - Country:US
Mailing Address - Phone:406-961-9611
Mailing Address - Fax:406-961-9014
Practice Address - Street 1:239 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2503
Practice Address - Country:US
Practice Address - Phone:406-961-9611
Practice Address - Fax:406-961-9014
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4395152W00000X
MT4258152W00000X
CO2555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU96677Medicare UPIN