Provider Demographics
NPI:1487877114
Name:W P ZUEGE,O.D., S.C.
Entity type:Organization
Organization Name:W P ZUEGE,O.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZUEGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-922-5430
Mailing Address - Street 1:110 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4369
Mailing Address - Country:US
Mailing Address - Phone:920-922-5430
Mailing Address - Fax:920-922-5478
Practice Address - Street 1:110 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4369
Practice Address - Country:US
Practice Address - Phone:920-922-5430
Practice Address - Fax:920-922-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487877114Medicaid
WI1487877114Medicaid
WI000087342Medicare PIN