Provider Demographics
NPI:1033266119
Name:SIMMONS, JANICE ANITA (OD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ANITA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:ANITA
Other - Last Name:SIMMONS-SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8862 PAPILLON DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4000
Mailing Address - Country:US
Mailing Address - Phone:410-258-5810
Mailing Address - Fax:014-269-4731
Practice Address - Street 1:15600 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1630
Practice Address - Country:US
Practice Address - Phone:301-421-9060
Practice Address - Fax:301-658-9004
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD907595000Medicaid
MDU95710Medicare UPIN