Provider Demographics
NPI:1689849010
Name:ZUZELSKI, SIDNEY JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:JOHN
Last Name:ZUZELSKI
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 1:762 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1978
Mailing Address - Country:US
Mailing Address - Phone:517-782-8353
Mailing Address - Fax:
Practice Address - Street 1:762 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1978
Practice Address - Country:US
Practice Address - Phone:517-782-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0-C8-6513OtherMEDICARE
MI1558826Medicaid
MIT71086Medicare UPIN