Provider Demographics
NPI:1548646524
Name:ZIMMER, JILLIAN E (OD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:TERRERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2865 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3912
Mailing Address - Country:US
Mailing Address - Phone:859-344-2079
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:2929 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2463
Practice Address - Country:US
Practice Address - Phone:513-559-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6415T3332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149355Medicaid
OHH508273Medicare PIN
OHH508271Medicare PIN
OHH508272Medicare PIN