Provider Demographics
NPI:1639233828
Name:ZUCKERMAN, ERIC JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAY
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20210 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1412
Mailing Address - Country:US
Mailing Address - Phone:248-476-4130
Mailing Address - Fax:248-476-2540
Practice Address - Street 1:20210 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-476-4130
Practice Address - Fax:248-476-2540
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008022207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE31662Medicare UPIN
MIP53790001Medicare PIN