MEDICARE: DR. JANICE ANITA SIMMONS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1197	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033266119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE ANITA SIMMONS OD

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	10050 BALTIMORE NATIONAL PIKE STE F100
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3684
Country	:	US
Telephone Number	:	410-461-2020
Fax Number	:	410-394-8054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	09/16/2024

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