Provider Demographics
NPI:1144847757
Name:ZIMMERMAN, EVAN JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:JOSEPH
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 1:5959 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2921
Mailing Address - Country:US
Mailing Address - Phone:231-845-6261
Mailing Address - Fax:231-843-9171
Practice Address - Street 1:1775 S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8533
Practice Address - Country:US
Practice Address - Phone:800-974-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist