Provider Demographics
NPI:1811086812
Name:FAY, JACQUELINE ZIGHERA (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ZIGHERA
Last Name:FAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1531 TAMIAMI TRAIL S.
Mailing Address - Street 2:SUITE 702A
Mailing Address - City:VANICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5569
Mailing Address - Country:US
Mailing Address - Phone:941-497-4451
Mailing Address - Fax:941-408-8971
Practice Address - Street 1:1531 TAMIAMI TRL S
Practice Address - Street 2:SUITE 702A
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5570
Practice Address - Country:US
Practice Address - Phone:941-497-4451
Practice Address - Fax:941-408-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU65117Medicare UPIN