Provider Demographics
NPI:1275342537
Name:ZIMMERLY, BRANDON (LDO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ZIMMERLY
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 JEP WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6536
Mailing Address - Country:US
Mailing Address - Phone:404-451-8685
Mailing Address - Fax:
Practice Address - Street 1:61 LINTON ST STE 2100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5098
Practice Address - Country:US
Practice Address - Phone:404-451-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002179156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician