Provider Demographics
NPI:1265501944
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:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSOLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-926-1001
Mailing Address - Street 1:711 S CALUMET
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-926-1001
Mailing Address - Fax:219-929-1989
Practice Address - Street 1:8554 S BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-0488
Practice Address - Fax:219-736-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0341340002Medicare NSC
IN651980Medicare PIN