=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346543147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZIEKER EYE OPHTHALMOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2010
-----------------------------------------------------
Last Update Date | 03/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 MOUNTAIN LEDGE
-----------------------------------------------------
City | WILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12831-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-450-1080
-----------------------------------------------------
Fax | 518-478-8500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 MOUNTAIN LEDGE DR.
-----------------------------------------------------
City | WILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12831-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-450-1080
-----------------------------------------------------
Fax | 518-478-8500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. CHRISTOPHER R ZIEKER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 518-450-1080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | 237533
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------