Provider Demographics
NPI:1417799743
Name:ZIGULIS, JAKOB TIVIS (OD)
Entity type:Individual
Prefix:DR
First Name:JAKOB
Middle Name:TIVIS
Last Name:ZIGULIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35430 EMORY DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4921
Mailing Address - Country:US
Mailing Address - Phone:419-377-0288
Mailing Address - Fax:
Practice Address - Street 1:2331 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4827
Practice Address - Country:US
Practice Address - Phone:419-626-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist