Provider Demographics
NPI:1588682496
Name:SHERYL SIMMS, O.D., P.C.
Entity Type:Organization
Organization Name:SHERYL SIMMS, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-692-9256
Mailing Address - Street 1:4960 S GILBERT RD STE 11
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5982
Mailing Address - Country:US
Mailing Address - Phone:480-802-7170
Mailing Address - Fax:480-802-3812
Practice Address - Street 1:4960 S GILBERT RD STE 11
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5982
Practice Address - Country:US
Practice Address - Phone:480-802-7170
Practice Address - Fax:480-802-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU58664Medicare UPIN