Provider Demographics
NPI:1699785055
Name:SIMMS, SUZANNE (OD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:SIMMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1716 UNIVERSITY BOULEVARD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BOULEVARD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS930TA504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009930510Medicaid
ALU80398OtherVIVA
MS00488352Medicaid
LA1586391Medicaid
AL51096440OtherBCBS
LA1586391Medicaid
AL000096440Medicare PIN
AL009930510Medicaid