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General NPI Number Information
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NPI Number | 1225206113
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Entity Type | Organization
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Legal Business Name | ASSOCIATION OF FAMILY OPTOMETRISTS,PC
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 301 E CARMEL DR SUITE F-300
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City | CARMEL
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State | IN
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Zip | 46032-2888
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Country | US
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Telephone | 317-848-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E CARMEL DR SUITE F-300
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City | CARMEL
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State | IN
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Zip | 46032-2888
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRELL SIMMERMAN
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Credential | OD
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Telephone | 317-418-5509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002063B
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License Number State | IN
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