Provider Demographics
NPI:1659343002
Name:SIMMONS, JAMES (OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2331
Mailing Address - Country:US
Mailing Address - Phone:716-882-1025
Mailing Address - Fax:716-882-5577
Practice Address - Street 1:1170 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2331
Practice Address - Country:US
Practice Address - Phone:716-882-1025
Practice Address - Fax:716-882-5577
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005472-1152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-0743930OtherTAX ID NUMBER