=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568992998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY M TOPPE OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2017
-----------------------------------------------------
Last Update Date | 08/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W BOGGSTOWN RD
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-398-9793
-----------------------------------------------------
Fax | 317-392-3444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 549
-----------------------------------------------------
City | WABASH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46992-0549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-569-9550
-----------------------------------------------------
Fax | 260-569-0760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 18004035
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------