Provider Demographics
NPI:1528262706
Name:SIMS, ANNETTE CHANG (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CHANG
Last Name:SIMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OAK ST STE 5
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7701
Mailing Address - Country:US
Mailing Address - Phone:541-687-2110
Mailing Address - Fax:541-484-3883
Practice Address - Street 1:1550 OAK ST STE 5
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7701
Practice Address - Country:US
Practice Address - Phone:541-687-2110
Practice Address - Fax:541-484-3883
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92904207W00000X
ORMD27653207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1528262706OtherRR MEDICARE
OR006394Medicaid
OR006394Medicaid