Provider Demographics
NPI:1407998982
Name:ZIMMERMAN, KIMBERLY A (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
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 1:513 S PITT ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3821
Mailing Address - Country:US
Mailing Address - Phone:717-245-2114
Mailing Address - Fax:
Practice Address - Street 1:2745 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1265
Practice Address - Country:US
Practice Address - Phone:717-238-6757
Practice Address - Fax:717-238-6541
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01940046Medicaid
PA01940046Medicaid
PA082280PW9Medicare ID - Type Unspecified