Basic Information
| Provider Information | |||||||||
| NPI: | 1124212519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAKAIM | ||||||||
| FirstName: | IRIT | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8315 BEECHMONT AVE | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452556140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134744444 | ||||||||
| FaxNumber: | 5134747915 | ||||||||
| Practice Location | |||||||||
| Address1: | 8315 BEECHMONT AVE | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452556140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134744444 | ||||||||
| FaxNumber: | 5134747915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5756/T2670 | OH | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 1710 DT | KY | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 11779602 | 01 | CAQH | OTHER | 000000547801 | 01 | OH | ANTHEM | OTHER |