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General NPI Number Information
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NPI Number | 1194858431
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Entity Type | Organization
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Legal Business Name | SIMMONS EYE CLINIC, LLC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 121 S RAILROAD AVE
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City | BROOKHAVEN
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State | MS
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Zip | 39601-3372
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Country | US
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Telephone | 601-823-3098
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Fax | 601-823-3099
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Provider Business Mailing Address
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Address Line | 121 S RAILROAD AVE
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City | BROOKHAVEN
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State | MS
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Zip | 39601-3372
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Country | US
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Telephone | 601-823-3098
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Fax | 601-823-3099
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUGENE SIMMONS JR.
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Credential | M.D.
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Telephone | 601-823-3098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 17670
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License Number State | MS
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