Healthcare Provider Details

I. General information

NPI: 1104493428
Provider Name (Legal Business Name): CARYN ZIMMERMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARYN GRIFFIN

II. Dates (important events)

Enumeration Date: 06/06/2021
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 W ASHLAN AVE
FRESNO CA
93705-1757
US

IV. Provider business mailing address

1790 E MANNING AVE
REEDLEY CA
93654-9467
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5497
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: