Provider Demographics
NPI:1104937556
Name:SIMMONS, NEIL (OD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4126
Mailing Address - Country:US
Mailing Address - Phone:601-267-7777
Mailing Address - Fax:601-267-7774
Practice Address - Street 1:110 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4126
Practice Address - Country:US
Practice Address - Phone:601-267-7777
Practice Address - Fax:601-267-7774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS563152W00000X, 152WC0802X, 152WX0102X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880215Medicaid
MS0495950001Medicare NSC
MS00880215Medicaid
MST90024Medicare UPIN