Provider Demographics
NPI:1982045522
Name:ZIMMERMAN, MARISSA (OD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
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 1:300 GARDEN CITY PLZ STE 404
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3332
Mailing Address - Country:US
Mailing Address - Phone:516-224-4888
Mailing Address - Fax:516-280-7052
Practice Address - Street 1:300 GARDEN CITY PLZ STE 404
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3332
Practice Address - Country:US
Practice Address - Phone:516-224-4888
Practice Address - Fax:516-280-7052
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008026-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist