Provider Demographics
NPI:1215933981
Name:SIMMERS, JAMIE CLAY (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:CLAY
Last Name:SIMMERS
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 1:186 HITES RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-5224
Mailing Address - Country:US
Mailing Address - Phone:540-869-5032
Mailing Address - Fax:
Practice Address - Street 1:125 PROSPERITY DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-5386
Practice Address - Country:US
Practice Address - Phone:540-869-8984
Practice Address - Fax:540-869-1693
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9235604Medicaid
VA010034621Medicaid
VAT21300Medicare UPIN
VA410000494Medicare ID - Type Unspecified