Healthcare Provider Details

I. General information

NPI: 1790024636
Provider Name (Legal Business Name): RICHARD E. SIMMONS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CALLE DE ALVAREZ SUITE D
LAS CRUCES NM
88005-3821
US

IV. Provider business mailing address

933 HIGH ST SUITE 220
WORTHINGTON OH
43085-4017
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-5367
  • Fax: 575-526-5057
Mailing address:
  • Phone: 575-526-5367
  • Fax: 575-526-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2006-0671
License Number StateNM

VIII. Authorized Official

Name: DR. RICHARD E. SIMMONS
Title or Position: OWNER/OPHTHALMOLOGIST
Credential: MD
Phone: 575-526-5367