MEDICARE: DR. HEBER GRANT SIMS O.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
1	152W00000X	Optometrist	565	SC
2	152WC0802X	Corneal and Contact Management Optometrist	565	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T244250281	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00607240	OTHER	SC	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588661649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEBER GRANT SIMS O.D.

Provider Business Mailing Address
First Line	:	353A E BLACKSTOCK RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3762
Country	:	US
Telephone Number	:	864-574-0366
Fax Number	:	864-574-0367

Provider Business Practice Location Address
First Line	:	353A E BLACKSTOCK RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3762
Country	:	US
Telephone Number	:	864-574-0366
Fax Number	:	864-574-0367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/08/2012

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