Provider Demographics
NPI:1164806782
Name:ZIMMERMAN, HEATHER ANITA (OD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANITA
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 1:101 NEW MEADOW RUN DR
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:FARMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15437-1391
Mailing Address - Country:US
Mailing Address - Phone:724-749-1513
Mailing Address - Fax:
Practice Address - Street 1:101 NEW MEADOW RUN DRIVE
Practice Address - Street 2:OAK VALLEY MEDICAL AND DENTAL, PC
Practice Address - City:FARMINGTON
Practice Address - State:PA
Practice Address - Zip Code:15437-0010
Practice Address - Country:US
Practice Address - Phone:724-749-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003097152W00000X
NYTUV008324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist