Basic Information
| Provider Information | |||||||||
| NPI: | 1619920535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIGULIS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7470 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481449607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348567070 | ||||||||
| FaxNumber: | 7348562092 | ||||||||
| Practice Location | |||||||||
| Address1: | 7470 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481449607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348567070 | ||||||||
| FaxNumber: | 7348562092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901003971 | MI | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 4816/T1681 | OH | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0P10040 | 01 | MI | MEDICARE PROVIDER # | OTHER |