Provider Demographics
NPI:1548301617
Name:ZELASKO, JOSEPH J (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:ZELASKO
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 1:4826 TACOMA MALL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7108
Mailing Address - Country:US
Mailing Address - Phone:253-475-0374
Mailing Address - Fax:253-475-9291
Practice Address - Street 1:4826 TACOMA MALL BLVD STE A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7108
Practice Address - Country:US
Practice Address - Phone:253-475-0374
Practice Address - Fax:253-475-9291
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD0001689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008811Medicaid
WAZE6347OtherREGENCE ID NUMBER
WA2031144Medicaid
WAZE6347OtherREGENCE ID NUMBER
WAT89040Medicare UPIN
WA2008811Medicaid