Healthcare Provider Details

I. General information

NPI: 1144847757
Provider Name (Legal Business Name): EVAN JOSEPH ZIMMERMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8984 E US HIGHWAY 20
NEW CARLISLE IN
46552-9038
US

IV. Provider business mailing address

8984 E US HIGHWAY 20
NEW CARLISLE IN
46552-9038
US

V. Phone/Fax

Practice location:
  • Phone: 574-654-8806
  • Fax:
Mailing address:
  • Phone: 574-654-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005459
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: