Provider Demographics
NPI:1689633877
Name:SIMMONS, ROBERT LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNN
Last Name:SIMMONS
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 1:12 N 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2952
Mailing Address - Country:US
Mailing Address - Phone:801-756-9627
Mailing Address - Fax:801-763-0126
Practice Address - Street 1:12 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2952
Practice Address - Country:US
Practice Address - Phone:801-756-9627
Practice Address - Fax:801-763-0126
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114653-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1689633877Medicaid
UT164679OtherDMBA
UT275926OtherALTIUS
UT87688OtherPEHP
UT87028357684003A004OtherTRICARE
UT87028357684003A004OtherTRICARE
UT1689633877Medicaid