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General NPI Number Information
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NPI Number | 1518974070
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Entity Type | Organization
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Legal Business Name | SIMMONS EYE CENTER
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 219 W CHESTNUT ST
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City | MARIANNA
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State | AR
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Zip | 72360-2212
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Country | US
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Telephone | 870-295-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 219 W. CHESTNUT
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City | MARIANNA
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State | AR
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Zip | 72360
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Country | US
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Telephone | 870-295-3636
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | JONATHAN SIMMONS
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Credential | OPTOMETRIST
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Telephone | 870-295-3636
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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 | 2390
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License Number State | AR
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