Provider Demographics
NPI:1578567483
Name:SIMMONS, JAMES C JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:SIMMONS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:411 STRANDER BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2959
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:STE 202
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2959
Practice Address - Country:US
Practice Address - Phone:206-575-4396
Practice Address - Fax:206-575-8615
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU34319Medicare UPIN
WAGAB27995Medicare PIN
WA0922340001Medicare ID - Type UnspecifiedDMER