Provider Demographics
NPI:1538110291
Name:ZUCKER, GERALD I (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:I
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8144 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1702
Mailing Address - Country:US
Mailing Address - Phone:219-836-1550
Mailing Address - Fax:219-826-1584
Practice Address - Street 1:8144 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1702
Practice Address - Country:US
Practice Address - Phone:219-836-1550
Practice Address - Fax:219-826-1584
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN152WOOOOOXOtherTAXONOMIES-OPTOMETRIST
IN112571OtherEYE-MED
IN112571OtherEYE-MED
IN962050Medicare ID - Type Unspecified