Provider Demographics
NPI:1073821138
Name:ASSOCIATION OF OPHTHALMOLOGY
Entity Type:Organization
Organization Name:ASSOCIATION OF OPHTHALMOLOGY
Other - Org Name:C NORTON SIMS MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:N
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-1345
Mailing Address - Street 1:3949 EVANS AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9335
Mailing Address - Country:US
Mailing Address - Phone:239-939-1345
Mailing Address - Fax:239-939-3675
Practice Address - Street 1:3949 EVANS AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9341
Practice Address - Country:US
Practice Address - Phone:239-939-1345
Practice Address - Fax:239-939-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36137207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043448500Medicaid
FL36137Medicare PIN
FL043448500Medicaid