Provider Demographics
NPI:1053485276
Name:SIMMONS, DERRICK FLOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:FLOYD
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-4018
Mailing Address - Country:US
Mailing Address - Phone:409-721-6972
Mailing Address - Fax:409-721-5492
Practice Address - Street 1:1810 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4018
Practice Address - Country:US
Practice Address - Phone:409-721-6972
Practice Address - Fax:409-721-5492
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3127 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3217TGOtherLICENSE #
TX76-0115941OtherTAX ID
TXOOE97UMedicare PIN