Provider Demographics
NPI:1891829131
Name:SIMMONS, CHERYL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:SIMMONS
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 1:1765 N TOWN EAST BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4151
Mailing Address - Country:US
Mailing Address - Phone:972-270-0892
Mailing Address - Fax:
Practice Address - Street 1:1765 N TOWN EAST BLVD STE 112
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4151
Practice Address - Country:US
Practice Address - Phone:972-270-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5839T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295856YTASMedicare PIN