Provider Demographics
NPI:1215990114
Name:SIMS, RICHARD J (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:SIMS
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1103 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2081
Practice Address - Country:US
Practice Address - Phone:517-676-9350
Practice Address - Fax:517-676-8040
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C31249OtherBLUE CROSS BLUE SHIELD
MIC36188002Medicare PIN
MI0C31249OtherBLUE CROSS BLUE SHIELD
MI0C36188Medicare ID - Type Unspecified
MIT96824Medicare UPIN