Provider Demographics
NPI:1386362127
Name:ZIMMERMAN, ALEXIS (OD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 127TH ST STE 221B
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2914
Mailing Address - Country:US
Mailing Address - Phone:321-888-9999
Mailing Address - Fax:312-530-0866
Practice Address - Street 1:15900 W 127TH ST STE 221B
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2914
Practice Address - Country:US
Practice Address - Phone:312-888-9999
Practice Address - Fax:312-530-0866
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist