Provider Demographics
NPI:1942386081
Name:ZIMMERMAN, CARL ERNEST (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ERNEST
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 1:700 S TELSHOR BLVD
Mailing Address - Street 2:SUITE #1534
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4669
Mailing Address - Country:US
Mailing Address - Phone:575-522-8334
Mailing Address - Fax:575-522-1065
Practice Address - Street 1:700 S TELSHOR BLVD
Practice Address - Street 2:SUITE #1534
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4669
Practice Address - Country:US
Practice Address - Phone:575-522-8334
Practice Address - Fax:575-522-1065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1944-TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management