MEDICARE: DR. MARK M. ZIMMER P.C

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	01967	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	BCBS OF IOWA	OTHER	IA	06297

General Provider Information

NPI Number	:	1376619247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MARK M. ZIMMER P.C

Provider Business Mailing Address
First Line	:	216 2ND ST NE
Second Line	:
City	:	INDEPENDENCE
State	:	IA
Zip	:	50644-1910
Country	:	US
Telephone Number	:	319-334-3631
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 2ND ST NE
Second Line	:
City	:	INDEPENDENCE
State	:	IA
Zip	:	50644-1910
Country	:	US
Telephone Number	:	319-334-3631
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK MATTHEW ZIMMER
Credential	:	OD
Telephone Number	:	319-334-3631

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	01/22/2008

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