Provider Demographics
NPI:1326013863
Name:SIMMS, STACEY E (OD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:E
Last Name:SIMMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13880 BRADDOCK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2460
Mailing Address - Country:US
Mailing Address - Phone:703-830-2020
Mailing Address - Fax:703-830-4458
Practice Address - Street 1:12110 SUNSET HILLS RD
Practice Address - Street 2:SUITE C-50
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5852
Practice Address - Country:US
Practice Address - Phone:703-834-9777
Practice Address - Fax:703-834-8187
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02182J02Medicare PIN
V07385Medicare UPIN