MEDICARE: DR. JILL N. WARFIELD-ZIEGERT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	18002593	IN

General Provider Information

NPI Number	:	1669507976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL N. WARFIELD-ZIEGERT O.D.

Provider Business Mailing Address
First Line	:	54669 OAK LEAF CT
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1862
Country	:	US
Telephone Number	:	574-255-5186
Fax Number	:	574-255-5186

Provider Business Practice Location Address
First Line	:	6501 GRAPE RD
Second Line	:	JCPENNEY OPTICAL
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1007
Country	:	US
Telephone Number	:	574-277-1176
Fax Number	:	574-277-1176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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