Provider Demographics
NPI:1720157662
Name:SIMMERMAN, LORNA H (OD)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:H
Last Name:SIMMERMAN
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 1:2710 CENTERVILLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1644
Mailing Address - Country:US
Mailing Address - Phone:302-993-1300
Mailing Address - Fax:302-993-1400
Practice Address - Street 1:2710 CENTERVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1644
Practice Address - Country:US
Practice Address - Phone:302-993-1300
Practice Address - Fax:302-993-1400
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00556500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
024024CAWMedicare UPIN