Provider Demographics
NPI:1144313305
Name:SIMMONS, THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-0979
Mailing Address - Country:US
Mailing Address - Phone:208-787-3937
Mailing Address - Fax:208-787-3939
Practice Address - Street 1:10 CEDRON RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:ID
Practice Address - Zip Code:83455-5015
Practice Address - Country:US
Practice Address - Phone:208-787-3937
Practice Address - Fax:208-787-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-10009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist