Healthcare Provider Details

I. General information

NPI: 1609498906
Provider Name (Legal Business Name): SIMMONS EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5278 N NEVADA AVE STE 120
COLORADO SPRINGS CO
80918-8720
US

IV. Provider business mailing address

320 E FONTANERO ST STE 201
COLORADO SPRINGS CO
80907-7525
US

V. Phone/Fax

Practice location:
  • Phone: 719-559-2020
  • Fax: 719-632-6088
Mailing address:
  • Phone: 719-599-2020
  • Fax: 719-632-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY NICOLE MAYLE
Title or Position: MANAGER
Credential:
Phone: 719-559-2020