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General NPI Number Information
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NPI Number | 1053614750
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Entity Type | Organization
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Legal Business Name | DANIEL J. ZYCH, INC
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Dates
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Enumeration Date | 12/19/2010
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Last Update Date | 12/19/2010
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Provider Practice Location Address
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Address Line | 2505 N OAK RD
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City | PLYMOUTH
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State | IN
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Zip | 46563-3410
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Country | US
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Telephone | 574-935-4224
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Fax | 574-935-4236
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Provider Business Mailing Address
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Address Line | 8970 WILLOW LN
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City | SAINT JOHN
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State | IN
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Zip | 46373-9383
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Country | US
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Telephone | 219-669-7564
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL J ZYCH
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Credential | O.D.
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Telephone | 219-669-7564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 18003474A
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License Number State | IN
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