Provider Demographics
NPI:1598753279
Name:SIMMONS EYE CARE CLINIC, P.A.
Entity Type:Organization
Organization Name:SIMMONS EYE CARE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-778-2363
Mailing Address - Street 1:113 W CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3317
Mailing Address - Country:US
Mailing Address - Phone:501-778-2363
Mailing Address - Fax:501-778-5329
Practice Address - Street 1:113 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3317
Practice Address - Country:US
Practice Address - Phone:501-778-2363
Practice Address - Fax:501-778-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105507022Medicaid
AR161893722Medicaid
AR139616722Medicaid
AR119106722Medicaid
AR49956OtherMEDICARE ID#
AR0250800001OtherPALMETTO DURABLE MEDICAL EQUIPMENT
AR119106722Medicaid
AR105507022Medicaid
ARU17397Medicare UPIN
AR139616722Medicaid
AR161893722Medicaid
AR0250800001Medicare NSC
ART20195Medicare UPIN