Provider Demographics
NPI:1194858431
Name:SIMMONS EYE CLINIC, LLC.
Entity type:Organization
Organization Name:SIMMONS EYE CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:601-823-3098
Mailing Address - Street 1:121 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3372
Mailing Address - Country:US
Mailing Address - Phone:601-823-3098
Mailing Address - Fax:601-823-3099
Practice Address - Street 1:121 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3372
Practice Address - Country:US
Practice Address - Phone:601-823-3098
Practice Address - Fax:601-823-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17670207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06428569Medicaid
MS06131738Medicaid
MS180000362Medicare PIN
MS06428569Medicaid
MS06131738Medicaid