MEDICARE: DR. MARK M 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
1	152W00000X	Optometrist	1967	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00000678	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	06297	OTHER	IA	BLUE CROSS & BLUE SHIELD
4	08106	OTHER	IA	BCBS FOR OELWEIN
5	43738	OTHER	IA	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689670598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK M ZIMMER OD

Provider Business Mailing Address
First Line	:	216 2ND ST NE
Second Line	:
City	:	INDEPENDENCE
State	:	IA
Zip	:	50644-1910
Country	:	US
Telephone Number	:	319-334-3631
Fax Number	:	319-334-3631

Provider Business Practice Location Address
First Line	:	216 2ND ST NE
Second Line	:
City	:	INDEPENDENCE
State	:	IA
Zip	:	50644-1910
Country	:	US
Telephone Number	:	319-334-3631
Fax Number	:	319-334-3631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	01/23/2008

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Directions to “ DR. MARK M ZIMMER OD” Practice Location

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