Provider Demographics
NPI:1093963043
Name:ZIMMERMAN, CINDY MARIE (OD)
Entity Type:Individual
Prefix:MISS
First Name:CINDY
Middle Name:MARIE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8918 MAGNOLIA VALE DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4135
Mailing Address - Country:US
Mailing Address - Phone:817-894-9319
Mailing Address - Fax:
Practice Address - Street 1:6333 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 272
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5448
Practice Address - Country:US
Practice Address - Phone:817-894-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7249TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist