Provider Demographics
NPI:1316131550
Name:SIMS, JOHN W (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SIMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-357-3511
Mailing Address - Fax:630-357-0556
Practice Address - Street 1:1331 W 75TH ST STE 403
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9336
Practice Address - Country:US
Practice Address - Phone:630-357-3511
Practice Address - Fax:630-357-0556
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL047106105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK08322Medicare PIN
ILT36279Medicare UPIN