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NPI Code Detail

MEDICARE: MICHAEL SIMMONS M.D.

MEDICARE: MICHAEL SIMMONS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician23619NV
2207W00000XOphthalmology Physician15234AWY
3207W00000XOphthalmology PhysicianMED-PHYS-LIC-115061MT
4207W00000XOphthalmology Physician13000441-1205UT

General Provider Information

NPI Number : 1194256479
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL SIMMONS M.D.
Provider Business Mailing Address
First Line : 4360 WASHINGTON BLVD
Second Line : ATTN CREDENTIALING
City : OGDEN
State : UT
Zip : 84403-1866
Country : US
Telephone Number : 801-476-0494
Fax Number : 801-409-9901
Provider Business Practice Location Address
First Line : 4360 WASHINGTON BLVD
Second Line : ATTN CREDENTIALING
City : OGDEN
State : UT
Zip : 84403-1866
Country : US
Telephone Number : 801-476-0494
Fax Number : 801-479-3937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2017
Last Update Date : 01/23/2026

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