Provider Demographics
NPI:1851435267
Name:SIDNEY J. ZUZELSKI OD PC
Entity Type:Organization
Organization Name:SIDNEY J. ZUZELSKI OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZUZELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-782-8353
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:517-787-9410
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:517-787-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558826Medicaid
MI0-C8-6513Medicare ID - Type Unspecified
MIT71086Medicare UPIN