Provider Demographics
NPI:1841473063
Name:SIMMONS, ANGEL NOVEL (OD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:NOVEL
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:MICHELLE
Other - Last Name:NOVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:PATIENT CARE CENTER
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4400
Mailing Address - Country:US
Mailing Address - Phone:314-516-5131
Mailing Address - Fax:314-516-5507
Practice Address - Street 1:7840 NATURAL BRIDGE RD
Practice Address - Street 2:PATIENT CARE CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4617
Practice Address - Country:US
Practice Address - Phone:314-516-5131
Practice Address - Fax:314-516-5507
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010023152W00000X
MO2004035653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010023Medicaid
MO1841473063Medicaid
MO067820027Medicare PIN
IL046010023Medicaid
MO1841473063Medicaid
MO074730002Medicare PIN