Provider Demographics
NPI:1043204480
Name:ZILM, MARK R (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:ZILM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:R
Other - Last Name:ZILM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR OF OPTOMETRY
Mailing Address - Street 1:3122 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4415
Mailing Address - Country:US
Mailing Address - Phone:970-945-2020
Mailing Address - Fax:970-945-5630
Practice Address - Street 1:3122 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4415
Practice Address - Country:US
Practice Address - Phone:970-945-2020
Practice Address - Fax:970-945-5630
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08115008Medicaid
CO08115008Medicaid
CF2613Medicare ID - Type Unspecified