MEDICARE: OLYMPUS EYECARE LLC

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	152W00000X	Optometrist	27TO00124500	NJ
2	152W00000X	Optometrist	6841	NY
3	152W00000X	Optometrist	27OA00584700	NJ

General Provider Information

NPI Number	:	1356624563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPUS EYECARE LLC

Provider Business Mailing Address
First Line	:	538 UNDERCLIFF AVE
Second Line	:	UNIT B
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1310
Country	:	US
Telephone Number	:	201-218-4485
Fax Number	:

Provider Business Practice Location Address
First Line	:	3907 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4819
Country	:	US
Telephone Number	:	201-865-8300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. INNA ZIMMERLING
Credential	:	OD
Telephone Number	:	201-218-4485

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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Directions to “OLYMPUS EYECARE LLC ” Practice Location

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