Provider Demographics
NPI:1811924228
Name:SIMMONDS, JENNIFER A (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SIMMONDS
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 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:195-761-8507
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:1901 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2106
Practice Address - Country:US
Practice Address - Phone:316-832-2838
Practice Address - Fax:316-832-9530
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398370AMedicaid
KS9802OtherPHS
KS12149446OtherMULTIPLAN
KS206318OtherHPK
KS650822OtherBCBS
KS82666OtherCOVENTRY
KS206318OtherHPK
U86460Medicare UPIN