Provider Demographics
NPI:1144952474
Name:HART, ZACKARY (OD)
Entity type:Individual
Prefix:
First Name:ZACKARY
Middle Name:
Last Name:HART
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 1:8009 S 180TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1042
Mailing Address - Country:US
Mailing Address - Phone:425-251-9200
Mailing Address - Fax:425-251-9201
Practice Address - Street 1:8009 S 180TH ST STE 104
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1042
Practice Address - Country:US
Practice Address - Phone:425-251-9200
Practice Address - Fax:425-251-9201
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61437237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty