Provider Demographics
NPI:1487822870
Name:ZIMMERMAN, TONI LAUREN (OD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:LAUREN
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:PO BOX PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-8000
Mailing Address - Country:US
Mailing Address - Phone:928-674-7166
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO ROUTE 4
Practice Address - Street 2:PINON HEALTH CENTER
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510-1127
Practice Address - Country:US
Practice Address - Phone:928-725-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001859152W00000X, 152W00000X
OH6094152W00000X
VT030.0080865152W00000X
NJ27OA00635600152W00000X
MI4901004671152W00000X
WI3244-35152W00000X
IN18003702A152W00000X
NYTUV007781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102711416Medicaid
240215Medicare PIN