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General NPI Number Information
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NPI Number | 1417799743
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Entity Type | Individual
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Provider Name | JAKOB TIVIS ZIGULIS OD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 2331 COLUMBUS AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-4827
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Country | US
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Telephone | 419-626-0272
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Fax |
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Provider Business Mailing Address
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Address Line | 35430 EMORY DR
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City | AVON
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State | OH
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Zip | 44011-4921
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Country | US
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Telephone | 419-377-0288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.007304
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License Number State | OH
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