Provider Demographics
NPI:1588661649
Name:SIMS, HEBER GRANT (OD)
Entity Type:Individual
Prefix:DR
First Name:HEBER
Middle Name:GRANT
Last Name:SIMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353A E BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3762
Mailing Address - Country:US
Mailing Address - Phone:864-574-0366
Mailing Address - Fax:864-574-0367
Practice Address - Street 1:353A E BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3762
Practice Address - Country:US
Practice Address - Phone:864-574-0366
Practice Address - Fax:864-574-0367
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC565152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT244250281OtherMEDICARE PTAN
SCP00607240OtherRAILROAD
SCDO5652Medicaid
SCT244250281OtherMEDICARE PTAN
SCT24425Medicare UPIN
SCT244250281Medicare PIN