Individual provider Active NPI

Zanna S Kruoch, OD

  • Optometrist
  • Dallas, TX
National Provider Identifier
1629208038
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
07404T Issued in TX
Practice address
2525 Lucas Dr
Dallas, TX 75219-1804
Phone
(214) 528-7354
Fax
(713) 743-0963
NPI assigned
Jul 20, 2009
Last updated
Sep 23, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 07404T TX Primary
Corneal and Contact Management Optometrist 152WC0802X 07404T TX

Addresses

Primary practice location

2525 Lucas Dr
Dallas, TX 75219-1804

Mailing address

2525 Lucas Dr
Dallas, TX 75219-1804
Phone (713) 743-2020

Other identifiers 1

IdentifierTypeStateIssuer
046010289MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230324002263 UT Practitioner - Optometry 0547314619 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
07404TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Mountain University of Health Professions Foundation Optometrist CurrentSince Jun 1, 2024 Accepting new patients
Uh Eye Care Optometrist Past Accepting new patients
University of Houston System Optometrist Past Accepting new patients

Locations

122 E 1700 S
Bldg 3
Provo, UT 84606
Phone (385) 248-5550

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1629208038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 LUCAS DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752191804",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 LUCAS DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752191804",
            "telephone_number": "214-528-7354",
            "fax_number": "713-743-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUOCH",
        "first_name": "ZANNA",
        "middle_name": "S",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "07404T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "07404T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046010289",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.