Healthcare Provider Details

I. General information

NPI: 1104907153
Provider Name (Legal Business Name): RONALD A ZUKER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W WESTERN AVE
MUSKEGON MI
49440-1110
US

IV. Provider business mailing address

442 W WESTERN AVE
MUSKEGON MI
49440-1110
US

V. Phone/Fax

Practice location:
  • Phone: 231-722-3556
  • Fax: 231-726-6334
Mailing address:
  • Phone: 231-722-3556
  • Fax: 231-726-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: