Provider Demographics
NPI:1164591848
Name:DOUGLAS A ZALE MD INC
Entity Type:Organization
Organization Name:DOUGLAS A ZALE MD INC
Other - Org Name:ZALE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-926-1001
Mailing Address - Street 1:711 S CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3220
Mailing Address - Country:US
Mailing Address - Phone:219-926-1001
Mailing Address - Fax:219-929-1989
Practice Address - Street 1:711 S CALUMET RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3220
Practice Address - Country:US
Practice Address - Phone:219-926-1001
Practice Address - Fax:219-929-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0341340001Medicare NSC
IN651980Medicare PIN