Provider Demographics
NPI:1437150588
Name:ZOELLICK, JULIE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MARIE
Last Name:ZOELLICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3428
Mailing Address - Country:US
Mailing Address - Phone:920-968-7546
Mailing Address - Fax:920-328-1442
Practice Address - Street 1:1307 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3428
Practice Address - Country:US
Practice Address - Phone:920-968-7546
Practice Address - Fax:920-328-1442
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2936-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38620400Medicaid
WIU97608Medicare UPIN
WI0004-47145Medicare ID - Type Unspecified