Provider Demographics
NPI:1689844805
Name:ANDREA D SIMS OD PC
Entity Type:Organization
Organization Name:ANDREA D SIMS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-221-3937
Mailing Address - Street 1:1320 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3965
Mailing Address - Country:US
Mailing Address - Phone:205-221-3937
Mailing Address - Fax:205-221-4417
Practice Address - Street 1:1320 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3965
Practice Address - Country:US
Practice Address - Phone:205-221-3937
Practice Address - Fax:205-221-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5618TA131152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058369Medicaid
AL0160320001Medicare NSC
AL000058369Medicaid
ALT69067Medicare UPIN