Provider Demographics
NPI:1558352146
Name:ZUEGE, W P (OD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:P
Last Name:ZUEGE
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 1:110 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4369
Mailing Address - Country:US
Mailing Address - Phone:920-922-5430
Mailing Address - Fax:
Practice Address - Street 1:110 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4369
Practice Address - Country:US
Practice Address - Phone:920-922-5430
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38561800Medicaid
WI38561800Medicaid
WI00087342Medicare ID - Type Unspecified