Healthcare Provider Details

I. General information

NPI: 1942555891
Provider Name (Legal Business Name): THE RETINA & MACULAR DEGENERATION CENTER OF SW FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 IMMOKALEE RD
NAPLES FL
34110-1401
US

IV. Provider business mailing address

1435 IMMOKALEE RD
NAPLES FL
34110-1401
US

V. Phone/Fax

Practice location:
  • Phone: 239-592-5511
  • Fax: 239-592-9259
Mailing address:
  • Phone: 239-592-5511
  • Fax: 239-592-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0057862
License Number StateFL

VIII. Authorized Official

Name: JEFFREY L ZIMM
Title or Position: PRESIDENT
Credential: MD
Phone: 239-592-5511