Provider Demographics
NPI:1740653252
Name:SIMMONS, ANTHONY (ABOC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W PLUM ST STE 310
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2166
Mailing Address - Country:US
Mailing Address - Phone:814-580-4176
Mailing Address - Fax:814-580-4176
Practice Address - Street 1:220 W PLUM ST STE 310
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2166
Practice Address - Country:US
Practice Address - Phone:814-580-4176
Practice Address - Fax:814-580-4176
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA138298156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician