Provider Demographics
NPI:1558305276
Name:ZIEBELL, JOSHUA THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THOMAS
Last Name:ZIEBELL
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 1:820 LOWER DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9368
Mailing Address - Country:US
Mailing Address - Phone:704-922-9808
Mailing Address - Fax:704-853-8029
Practice Address - Street 1:820 LOWER DALLAS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9368
Practice Address - Country:US
Practice Address - Phone:704-922-9808
Practice Address - Fax:704-853-8029
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410007312OtherMEDICARE - GEORGIA
NC30632OtherOPTICARE
NC2399655OtherUNITED HEALTHCARE
NC89093PGMedicaid
NC093PGOtherBCBS
NC804273OtherPARTNERS MEDICARE CHOICE
NC30632OtherOPTICARE
NC2399655OtherUNITED HEALTHCARE
NC804273OtherPARTNERS MEDICARE CHOICE