Provider Demographics
NPI:1619920535
Name:ZIGULIS, JEFFREY THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:ZIGULIS
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 1:1073 PRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-8712
Mailing Address - Country:US
Mailing Address - Phone:567-952-2020
Mailing Address - Fax:567-952-2142
Practice Address - Street 1:1073 PRAY BLVD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-8712
Practice Address - Country:US
Practice Address - Phone:567-952-2020
Practice Address - Fax:567-952-2142
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003971152W00000X
OH4816/T1681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P10040OtherMEDICARE PROVIDER #
MI0P10040OtherMEDICARE PROVIDER #
MI4714510001Medicare NSC
MI0P10040001Medicare PIN
MIP10040001Medicare PIN
U46117Medicare UPIN