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NPI Code Detail

MEDICARE: JAY S ZIMMERMAN OD

MEDICARE: JAY S ZIMMERMAN 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
1152W00000XOptometristTUV006778NY

General Provider Information

NPI Number : 1912902180
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY S ZIMMERMAN OD
Provider Business Mailing Address
First Line : 3095 HARLEM RD
Second Line :
City : CHEEKTOWAGA
State : NY
Zip : 14225-2500
Country : US
Telephone Number : 716-896-8831
Fax Number : 716-896-2318
Provider Business Practice Location Address
First Line : 3095 HARLEM RD
Second Line :
City : CHEEKTOWAGA
State : NY
Zip : 14225-2500
Country : US
Telephone Number : 716-896-8831
Fax Number : 716-896-2318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 07/08/2007

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