Provider Demographics
NPI:1811969736
Name:ZIMMERMAN, RICHARD R (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8162 S 59TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9235
Mailing Address - Country:US
Mailing Address - Phone:414-421-6131
Mailing Address - Fax:
Practice Address - Street 1:4850 S 74TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4359
Practice Address - Country:US
Practice Address - Phone:414-282-3308
Practice Address - Fax:414-325-8770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63754Medicare UPIN