Provider Demographics
NPI:1285700153
Name:DR MARK M ZIMMER PC
Entity type:Organization
Organization Name:DR MARK M ZIMMER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:319-444-2126
Mailing Address - Street 1:216 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-1910
Mailing Address - Country:US
Mailing Address - Phone:319-334-3631
Mailing Address - Fax:
Practice Address - Street 1:216 2ND ST NE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-1910
Practice Address - Country:US
Practice Address - Phone:319-334-3631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR MARK M ZIMMER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3078170Medicaid
IA43738OtherBCBS OF IOWA
IA4686720003OtherDMERC
IA3078170Medicaid
IA43738OtherBCBS OF IOWA
IAI9238Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER