Provider Demographics
NPI:1467688945
Name:JAMES C. SIMMONS
Entity Type:Organization
Organization Name:JAMES C. SIMMONS
Other - Org Name:EYE 5 OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMMOMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-575-4396
Mailing Address - Street 1:411 STRANDER BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2935
Mailing Address - Country:US
Mailing Address - Phone:206-575-4396
Mailing Address - Fax:206-575-8615
Practice Address - Street 1:411 STRANDER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2935
Practice Address - Country:US
Practice Address - Phone:206-575-4396
Practice Address - Fax:206-575-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0922340001Medicare NSC