Provider Demographics
NPI:1235305558
Name:NEIL H. SIMMONS, O.D., P.A.
Entity Type:Organization
Organization Name:NEIL H. SIMMONS, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-267-7777
Mailing Address - Street 1:110 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4126
Mailing Address - Country:US
Mailing Address - Phone:601-267-7777
Mailing Address - Fax:601-267-7774
Practice Address - Street 1:110 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4126
Practice Address - Country:US
Practice Address - Phone:601-267-7777
Practice Address - Fax:601-267-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880215Medicaid
MS410000046OtherMEDICARE
MST90024Medicare UPIN
MS0495950001Medicare NSC