Provider Demographics
NPI:1356476709
Name:SIMMONS, RICK
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4678 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3055
Mailing Address - Country:US
Mailing Address - Phone:914-738-2885
Mailing Address - Fax:914-738-2932
Practice Address - Street 1:4678 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3055
Practice Address - Country:US
Practice Address - Phone:914-738-2885
Practice Address - Fax:914-738-2932
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006056-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician