Healthcare Provider Details

I. General information

NPI: 1689844805
Provider Name (Legal Business Name): ANDREA D SIMS OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 HIGHWAY 78 E
JASPER AL
35501-3965
US

IV. Provider business mailing address

1320 HIGHWAY 78 E
JASPER AL
35501-3965
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-3937
  • Fax: 205-221-4417
Mailing address:
  • Phone: 205-221-3937
  • Fax: 205-221-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5618TA131
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA D SIMS
Title or Position: OWNER PRESIDENT DOCTOR
Credential: OD
Phone: 205-221-3937