Provider Demographics
NPI:1134287998
Name:ZIMMERMAN, JAMES E (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 DEPTFORD CENTER RD
Mailing Address - Street 2:DEPTFORD MALL # 1172
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-848-6400
Mailing Address - Fax:
Practice Address - Street 1:1750 DEPTFORD CENTER RD
Practice Address - Street 2:DEPTFORD MALL # 1172
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5222
Practice Address - Country:US
Practice Address - Phone:856-848-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA3552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ156624Medicare ID - Type Unspecified