Healthcare Provider Details

I. General information

NPI: 1215933981
Provider Name (Legal Business Name): JAMIE CLAY SIMMERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PROSPERITY DRIVE SUITE 400
WINCHESTER VA
22602-5386
US

IV. Provider business mailing address

186 HITES RD
STEPHENS CITY VA
22655-5224
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-8984
  • Fax: 540-869-1693
Mailing address:
  • Phone: 540-869-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0601001538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: