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General NPI Number Information
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NPI Number | 1598753279
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Entity Type | Organization
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Legal Business Name | SIMMONS EYE CARE CLINIC, P.A.
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 113 W CARPENTER ST
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City | BENTON
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State | AR
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Zip | 72015-3317
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Country | US
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Telephone | 501-778-2363
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Fax | 501-778-5329
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Provider Business Mailing Address
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Address Line | 113 W CARPENTER ST
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City | BENTON
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State | AR
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Zip | 72015-3317
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Country | US
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Telephone | 501-778-2363
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Fax | 501-778-5329
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. RUSSELL T. SIMMONS
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Credential | O.D.
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Telephone | 501-778-2363
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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 | 2329
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License Number State | AR
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