Healthcare Provider Details

I. General information

NPI: 1528262706
Provider Name (Legal Business Name): ANNETTE CHANG SIMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 OAK ST STE 5
EUGENE OR
97401-7701
US

IV. Provider business mailing address

1550 OAK ST STE 5
EUGENE OR
97401-7701
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-2110
  • Fax: 541-484-3883
Mailing address:
  • Phone: 541-687-2110
  • Fax: 541-484-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME92904
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD27653
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD27653
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1528262706
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRR MEDICARE
# 2
Identifier006394
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: