Provider Demographics
NPI:1760434864
Name:SIMNACHER, JAMES L (OD, PA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:SIMNACHER
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-1390
Mailing Address - Country:US
Mailing Address - Phone:575-762-4463
Mailing Address - Fax:575-762-7231
Practice Address - Street 1:901 E 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4400
Practice Address - Country:US
Practice Address - Phone:575-762-4463
Practice Address - Fax:575-762-7231
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP5291Medicaid
NM2591108Medicare ID - Type Unspecified
NMT74968Medicare UPIN
NM0614010001Medicare NSC