Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1756 | KS |
Y | 152W00000X | Optometrist | OPT-2588 | CO |
NPI | 1003909482 |
---|---|
Provider Name | Dr. Blake G. Simmons |
First Address | Colorado Springs, CO 80907-7525 |
Second Address | Colorado Springs, CO 80907-7525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 09/03/2017 |