Healthcare Provider Details

I. General information

NPI: 1194858431
Provider Name (Legal Business Name): SIMMONS EYE CLINIC, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S RAILROAD AVE
BROOKHAVEN MS
39601-3372
US

IV. Provider business mailing address

121 S RAILROAD AVE
BROOKHAVEN MS
39601-3372
US

V. Phone/Fax

Practice location:
  • Phone: 601-823-3098
  • Fax: 601-823-3099
Mailing address:
  • Phone: 601-823-3098
  • Fax: 601-823-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17670
License Number StateMS

VIII. Authorized Official

Name: DR. EUGENE SIMMONS JR.
Title or Position: OWNER
Credential: M.D.
Phone: 601-823-3098