Provider Demographics
NPI:1548753122
Name:ZIEGLER, SAMANTHA (OD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 DUCKWOOD DR STE 14
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1194
Mailing Address - Country:US
Mailing Address - Phone:651-349-4699
Mailing Address - Fax:651-452-1564
Practice Address - Street 1:1340 DUCKWOOD DR STE 14
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1194
Practice Address - Country:US
Practice Address - Phone:651-349-4699
Practice Address - Fax:651-452-1564
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3562152W00000X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3562OtherMINNESOTA LICENSE