Provider Demographics
NPI:1942188107
Name:BOGOSIAN, ZACHARY MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:MATTHEW
Last Name:BOGOSIAN
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 1:225 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1409
Mailing Address - Country:US
Mailing Address - Phone:716-261-2400
Mailing Address - Fax:
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1409
Practice Address - Country:US
Practice Address - Phone:716-261-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist