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NPI Code Detail

MEDICARE: MARISSA ZIMMERMAN OD

MEDICARE: MARISSA 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
1152W00000XOptometristTUV008026-1NY

General Provider Information

NPI Number : 1982045522
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA ZIMMERMAN OD
Provider Business Mailing Address
First Line : 300 GARDEN CITY PLZ STE 404
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-3332
Country : US
Telephone Number : 516-224-4888
Fax Number : 516-280-7052
Provider Business Practice Location Address
First Line : 300 GARDEN CITY PLZ STE 404
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-3332
Country : US
Telephone Number : 516-224-4888
Fax Number : 516-280-7052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2013
Last Update Date : 11/10/2022

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