NPIMap

Organization Active NPI

Dr. Mark M. Zimmer P.C

  • Optometrist
  • Independence, IA
National Provider Identifier
1376619247
Registry record updated Jan 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
01967 Issued in IA
Legal business name
DR. MARK M. ZIMMER P.C
Practice address
216 2ND St NE
Independence, IA 50644-1910
Phone
(319) 334-3631
NPI assigned
Nov 24, 2006
Last updated
Jan 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Matthew Zimmer, ODNPI 1689670598
Title
President
Phone
(319) 334-3631

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 01967 IA Primary

Addresses

Primary practice location

216 2ND St NE
Independence, IA 50644-1910

Mailing address

216 2ND St NE
Independence, IA 50644-1910
Phone (319) 334-3631

Other identifiers 3

IdentifierTypeStateIssuer
0419424MedicaidIA
5078170MedicaidIA
BCBS OF IOWAOtherIA06297

National Provider Directory

National Provider Directory

Locations

216 2nd St NE
Independence, IA 50644
Phone (319) 331-3631

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200960000000",
    "number": "1376619247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 2ND ST NE",
            "city": "INDEPENDENCE",
            "state": "IA",
            "postal_code": "506441910",
            "telephone_number": "319-334-3631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 2ND ST NE",
            "city": "INDEPENDENCE",
            "state": "IA",
            "postal_code": "506441910",
            "telephone_number": "319-334-3631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MARK M. ZIMMER P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2008-01-22",
        "status": "A",
        "authorized_official_last_name": "ZIMMER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-334-3631",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0419424",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5078170",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "06297",
            "identifier": "BCBS OF IOWA",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.