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NPI Code Detail

MEDICARE: STEVEN A ZIMMER OD

MEDICARE: STEVEN A ZIMMER OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1672MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366437758
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN A ZIMMER OD
Provider Business Mailing Address
First Line : 11725 STINSON AVE
Second Line :
City : CHISAGO CITY
State : MN
Zip : 55013-9542
Country : US
Telephone Number : 651-257-8421
Fax Number : 651-257-8464
Provider Business Practice Location Address
First Line : 11725 STINSON AVE
Second Line :
City : CHISAGO CITY
State : MN
Zip : 55013-9542
Country : US
Telephone Number : 651-257-8421
Fax Number : 651-257-8464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 11/14/2013

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