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General NPI Number Information
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NPI Number | 1811675580
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Entity Type | Individual
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Provider Name | DR. WESLEY SIMMONS
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Gender | Male
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 25 STERLING WAY STE C
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City | MOUNT STERLING
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State | KY
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Zip | 40353-1174
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Country | US
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Telephone | 859-498-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 3561 CAMERON HILLS PL
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City | ELLENWOOD
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State | GA
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Zip | 30294-1475
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Country | US
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Telephone | 404-394-1736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2340DT
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License Number State | KY
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