Provider Demographics
NPI:1750447017
Name:SIMS, ANDREA DEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DEE
Last Name:SIMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 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
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-618-TA-131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058369Medicaid
ALT69067OtherHEALTH SPRINGS
ALT69067OtherVIVA
AL51058369OtherBLUE CROSS BLUE SHIELD
ALT69067OtherHEALTH SPRINGS
ALT69067Medicare UPIN
AL410021046Medicare PIN
AL000058369Medicaid