Healthcare Provider Details

I. General information

NPI: 1285700153
Provider Name (Legal Business Name): DR MARK M ZIMMER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 2ND ST NE
INDEPENDENCE IA
50644-1910
US

IV. Provider business mailing address

216 2ND ST NE
INDEPENDENCE IA
50644-1910
US

V. Phone/Fax

Practice location:
  • Phone: 319-334-3631
  • Fax:
Mailing address:
  • Phone: 319-334-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number01967
License Number StateIA

VIII. Authorized Official

Name: DR. MARK MATTHEW ZIMMER II
Title or Position: PRESIDENT
Credential: OD
Phone: 319-444-2126