MEDICARE: DR. ALLISON SUE ZAUM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12030T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ65828Z	OTHER	CA	BLUE SHIELD PROVIDER ID

General Provider Information

NPI Number	:	1770563553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON SUE ZAUM O.D.

Provider Business Mailing Address
First Line	:	1040 N RENGSTORFF AVE
Second Line	:	SUITE B
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1750
Country	:	US
Telephone Number	:	650-968-3937
Fax Number	:	650-968-4082

Provider Business Practice Location Address
First Line	:	1040 N RENGSTORFF AVE
Second Line	:	SUITE B
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1750
Country	:	US
Telephone Number	:	650-968-3937
Fax Number	:	650-968-4082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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