Provider Demographics
NPI:1669507976
Name:WARFIELD-ZIEGERT, JILL N (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:N
Last Name:WARFIELD-ZIEGERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:54669 OAK LEAF CT
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1862
Mailing Address - Country:US
Mailing Address - Phone:574-255-5186
Mailing Address - Fax:574-255-5186
Practice Address - Street 1:6501 GRAPE RD
Practice Address - Street 2:JCPENNEY OPTICAL
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1007
Practice Address - Country:US
Practice Address - Phone:574-277-1176
Practice Address - Fax:574-277-1176
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002593152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37142Medicare UPIN