Provider Demographics
NPI:1053614750
Name:DANIEL J. ZYCH, INC
Entity type:Organization
Organization Name:DANIEL J. ZYCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZYCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-669-7564
Mailing Address - Street 1:8970 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9383
Mailing Address - Country:US
Mailing Address - Phone:219-669-7564
Mailing Address - Fax:
Practice Address - Street 1:2505 N OAK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-3410
Practice Address - Country:US
Practice Address - Phone:574-935-4224
Practice Address - Fax:574-935-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003474A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier