MEDICARE: SIMMONS EYE CENTER

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	2390	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5G067	OTHER	AR	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5G067	OTHER	AR	BC/BS GROUP

General Provider Information

NPI Number	:	1518974070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMMONS EYE CENTER

Provider Business Mailing Address
First Line	:	219 W. CHESTNUT
Second Line	:
City	:	MARIANNA
State	:	AR
Zip	:	72360
Country	:	US
Telephone Number	:	870-295-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 W CHESTNUT ST
Second Line	:
City	:	MARIANNA
State	:	AR
Zip	:	72360-2212
Country	:	US
Telephone Number	:	870-295-3636
Fax Number	:

Authorized Official
Title or Position	:	OWNER OPTOMETRIST
Name	:	JONATHAN SIMMONS
Credential	:	OPTOMETRIST
Telephone Number	:	870-295-3636

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/30/2010

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Directions to “SIMMONS EYE CENTER ” Practice Location

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