Provider Demographics
NPI:1144518051
Name:ZEMANOVICH, MATTHEW JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:ZEMANOVICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:360 NUECES ST
Mailing Address - Street 2:SUITE 70
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4195
Mailing Address - Country:US
Mailing Address - Phone:512-472-3937
Mailing Address - Fax:512-472-3938
Practice Address - Street 1:360 NUECES ST
Practice Address - Street 2:SUITE 70
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4195
Practice Address - Country:US
Practice Address - Phone:512-472-3937
Practice Address - Fax:512-472-3938
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8035TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB164682Medicare PIN