Healthcare Provider Details

I. General information

NPI: 1558305276
Provider Name (Legal Business Name): JOSHUA THOMAS ZIEBELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LOWER DALLAS HWY
DALLAS NC
28034-9368
US

IV. Provider business mailing address

820 LOWER DALLAS HWY
DALLAS NC
28034-9368
US

V. Phone/Fax

Practice location:
  • Phone: 704-922-9808
  • Fax: 704-853-8029
Mailing address:
  • Phone: 704-922-9808
  • Fax: 704-853-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1884
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: