Healthcare Provider Details

I. General information

NPI: 1215915251
Provider Name (Legal Business Name): ELIZABETH M ZINGULA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E BUTLER ST
MANCHESTER IA
52057-0308
US

IV. Provider business mailing address

105 E BUTLER ST PO BOX 308
MANCHESTER IA
52057-0308
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-3759
  • Fax: 563-927-5582
Mailing address:
  • Phone: 563-927-3759
  • Fax: 563-927-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02312
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: