Healthcare Provider Details

I. General information

NPI: 1598923955
Provider Name (Legal Business Name): DR. H. G. SIMS, OPTOMETRIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2008
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E BLACKSTOCK RD STE A
SPARTANBURG SC
29301-3785
US

IV. Provider business mailing address

353 E BLACKSTOCK RD STE A
SPARTANBURG SC
29301-3785
US

V. Phone/Fax

Practice location:
  • Phone: 864-574-0366
  • Fax: 864-574-0367
Mailing address:
  • Phone: 864-574-0366
  • Fax: 864-574-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number565
License Number StateSC

VIII. Authorized Official

Name: DR. HEBER GRANT SIMS
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 864-574-0366