Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 563 | MS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 563 | MS |
N | 152WP0200X | Pediatric Optomitrist | 563 | MS |
N | 152WS0006X | Sports Vision | 563 | MS |
N | 152WX0102X | Occupational Vision | 563 | MS |
NPI | 1104937556 |
---|---|
Provider Name | Dr. Neil Simmons |
First Address | Carthage, MS 39051-4126 |
Second Address | Carthage, MS 39051-4126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00880215 | (05) | MS |
T90024 | (02) | MS |