MEDICARE: JEFF SIMMONS OD

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1235697632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF SIMMONS OD

Provider Business Mailing Address
First Line	:	5474 W DAYBREAK PKWY STE G3
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5909
Country	:	US
Telephone Number	:	801-923-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	5474 W DAYBREAK PKWY STE G3
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5909
Country	:	US
Telephone Number	:	801-923-3935
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	JEFF SIMMONS
Credential	:	OD
Telephone Number	:	801-923-3935

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	06/19/2023

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