Provider Demographics
NPI:1770563553
Name:ZAUM, ALLISON SUE (OD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:SUE
Last Name:ZAUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1040 N RENGSTORFF AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1750
Mailing Address - Country:US
Mailing Address - Phone:650-968-3937
Mailing Address - Fax:650-968-4082
Practice Address - Street 1:1040 N RENGSTORFF AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1750
Practice Address - Country:US
Practice Address - Phone:650-968-3937
Practice Address - Fax:650-968-4082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12030T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65828ZOtherBLUE SHIELD PROVIDER ID
CASD0120301Medicare ID - Type UnspecifiedPPIN
CAZZZ03395ZMedicare ID - Type Unspecified
CAV04039Medicare UPIN