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General NPI Number Information
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NPI Number | 1710078019
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Entity Type | Organization
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Legal Business Name | DR MARK M ZIMMER PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 12 1ST AVE NE
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City | OELWEIN
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State | IA
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Zip | 50662-1737
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Country | US
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Telephone | 319-283-3155
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Fax | 319-283-3155
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Provider Business Mailing Address
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Address Line | 12 1ST AVE NE
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City | OELWEIN
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State | IA
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Zip | 50662-1737
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Country | US
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Telephone | 319-283-3155
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Fax | 319-283-3155
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK MATTHEW ZIMMER
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Credential | OD
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Telephone | 319-283-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 01967
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License Number State | IA
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