Provider Demographics
NPI:1790095230
Name:DAVID W ZAUEL PROFESSIONAL CORP
Entity Type:Organization
Organization Name:DAVID W ZAUEL PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZAUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-745-2350
Mailing Address - Street 1:1 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9401
Mailing Address - Country:US
Mailing Address - Phone:317-745-2350
Mailing Address - Fax:317-745-4145
Practice Address - Street 1:1 MANOR DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9401
Practice Address - Country:US
Practice Address - Phone:317-745-2350
Practice Address - Fax:317-745-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029055A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201028900A/BMedicaid
IN182943165Medicare Oscar/Certification
IN201028900A/BMedicaid
IN180006703Medicare Oscar/Certification
IN681540Medicare PIN